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Fluids & Electrolytes
A CHEST TUBE is inserted to remove air, blood, or excess fluid from the pleural space and reexpand the involved lung. If your patient has a traditional water-seal chest drainage unit (CDU), you'll need to manage the system.
* Keep the system closed and below chest level. Make sure all connections are taped and the chest tube is secured to the chest wall.
* Ensure that the suction control chamber is filled with sterile water to the 20-cm level or as prescribed. If using suction, make sure the suction unit's pressure level causes slow but steady bubbling in the suction control chamber.
Make sure the water-seal chamber is filled with sterile water to the level specified by the manufacturer. You should see fluctuation (tidaling) of the fluid level in the water-seal chamber; if you don't, the system may not be patent or working properly, or the patient's lung may have reexpanded.
Look for constant or intermittent bubbling in the water-seal chamber, which indicates leaks in the drainage system. Identify and correct external leaks. Notify the health care provider immediately if you can't identify an external leak or correct it.
* Assess the amount, color, and consistency of drainage in the drainage tubing and in the collection chamber. Mark the drainage level on the outside of the collection chamber (with date, time, and initials) every 8 hours or more frequently if indicated. Report drainage that's excessive, cloudy, or unexpectedly bloody.
* Encourage the patient to perform deep breathing, coughing, and incentive spirometry. Assist with repositioning or ambulation as ordered. Provide adequate analgesia.
* Assess vital signs, breath sounds, SpO2, and insertion site for subcutaneous emphysema as ordered.
* When the chest tube is removed, immediately apply a sterile occlusive petroleum gauze dressing over the site to prevent air from entering the pleural space.
* Don't let the drainage tubing kink, loop, or interfere with the patient's movement.
* Don't clamp a chest tube, except momentarily when replacing the CDU, assessing for an air leak, or assessing the patient's tolerance of chest tube removal, and during chest tube removal.
* Don't aggressively manipulate the chest tube; don't strip or milk it.
Coughlin AM, Parchinsky C. Go with the flow of chest tube therapy. Nursing2006. 36(3):36-41, March 2006.
Lazzara D. Eliminate the air of mystery from chest tubes. Nursing2002. 2(6):36-43, June 2002.
Smeltzer SC, et al. Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 11th edition. Lippincott Williams & Wilkins, 2007.
Sole ML, et al. (eds). Introduction to Critical Care Nursing, 4th edition. Elsevier, 2005.
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