CHEST

DRAINAGE
SYSTEMS
Normal Breathing
Mechanism
 Operates on the principle of negative
pressure
 Pressure in the chest cavity is lower

than the atmosphere, causing air to

move into the lungs during
inspiration.
 When chest is opened, there is loss

of negative pressure which can

collapse a lung.
Chest Drainage Systems
 Crucial intervention for improving gas
exchange and breathing
 Chest drainage therapy involves the
removal of air, blood, pus, or other
secretions from the chest cavity.
 Installing a chest drainage tube can be
either an emergency or a planned
procedure.
 Removing air or fluids from the chest
involves the insertion of a tube through the
skin and the muscles between the ribs, and
into the chest cavity.
 This cavity is also called the pleural space.
Who May Need One
 Conditions that may need to be treated
by chest drainage therapy include:
 Emphysema
 Tuberculosis
 spontaneous pneumothorax that causes
more than a 25% collapse of the lung.
 cancer that causes excessive secretions
Who Needs One Continues
 Emphysema (pus in the thoracic cavity)
 Hemothorax (blood in the thoracic
cavity).
 In cases where the lung is collapsed,
removing fluids by chest drainage
therapy allows the lung to reinflate.
 Oftentimes an x ray is performed prior to
treatment to determine whether the
problem is either fluid or air in the
pleural space.
Types of Chest Tubes
 Small-bore
 One way valve apparatus to prevent air
from moving back into the patient
 Inserted through small incision

 Large-bore
 Usually
connected to a chest drainage
system to collect any pleural fluid and
monitor for air leaks.
Chest Drainage Insertion
 Most patients are awake when the
chest drainage tube is inserted.
 They are given a sedative and a local

anesthetic.
 Chest drainage tubes are usually

inserted between the ribs.

 The exact location depends on the

type of material to be drained and its

location in the lungs.
Continued
 The chest drainage system must remain
sealed to prevent air from entering the
chest cavity through the tube.
 One commonly used system is a water-
seal drainage system, comprised of
three compartments that collect and
drain the fluid or air without allowing air
to backflow into the tube.
 Once the tube and drainage system are
in place, a chest x ray is done to confirm
that the tube is in the right location, and
that it is working.
Types of Drainage Systems
 Traditional water seal
3 chambers, collection, water seal
(middle) and wet suction control
Requires sterile fluid be instilled
into water seal and suction
chamber
+ and – pressure release valves
Intermittent bubbling indicates
system is functioning properly
Types Continued
 Dry suction water seal
 3 chambers like traditional
 Requires sterile fluid be instilled in water
seal chamber at 2-cm level
 No need to fill suction chamber with fluid
 + and _ pressure release valves
 Indicator to signify suction pressure is
adequate
 Quieter than traditional
Types continued
 Dry suction
 One way mechanical suction that allows
air to leave the chest and prevents from
moving back into chest
 Also referred to as one way valve
system
 No need to fill suction chamber with
fluid, can be set up quickly in
emergency
 Works even if knocked over, great for
ambulatory patients
Special Considerations
 Newborns may develop multiple
pneumothoraxes requiring multiple
chest tubes.
 Units have smaller collection chambers
and finer calibrations to allow more
accurate measurement of small drainage
volumes.
 The connecting tube has a narrower
diameter to allow connection to the
smaller chest tubes used in these
patients.
Nursing Management
 Ensure drainage tubing does not kink,
loop or interfere with the patient’s
movements to prevent fluid back up into
the pleural space or impede drainage.
 Assist patient with range of motion to
reduce post op pain and prevent
ankylosis of the shoulder.
 Milk tubing in direction of drainage
system as needed to prevent tubing
from becoming obstructed by clots and
fibrin.
Nursing Management
Continued
 Make sure there is fluctuation (tidaling)
of the fluid level in the water seal
chamber, shows effective connection
 Fluid fluctuations in the water seal
chamber or air leak indicator are will
stop when
 Lung has reexpanded
 Tubing is obstructed

 Lop of tubing hangs below rest of tubing

 Suction motor or wall suction is not working

Nursing Management
Continued
 Monitor for air leaks to prevent tension
pneumothorax.
 Notify MD if excessive bubbling in water
seal chamber not due to external leaks.
 Assess for rapid and shallow breathing,
cyanosis, pressure in chest, symptoms of
hemorrhage to significant changes in VS
 Encourage deep breathing a coughing to
help aisle pleural raise and promotion of
accumulated fluid in pleural space.
Nursing Management
Continued
 Keep system below chest level
 Keep suction at prescribed level
 Keep air vent open when suction is off.
 Never let the drainage tube dangle. As
part of your routine care, make sure it's
coiled on the bed.
Nursing Management
Continued
 Pneumothorax, expect little if any output
because the tube is draining air, not fluid.
 Hemothorax, a lack of drainage may
indicate a clot obstructing the tube. If that
occurs, try milking the tube: Starting at the
proximal end, gently squeeze and release it
between your fingers along the length of
the tubing.
 However, don't “strip” the chest tube,
which means squeezing the length of the
tube without releasing it. Once a common
practice, stripping the tube causes a
dangerous increase in intrathoracic
pressure and doesn't lead to any significant
increase in output.
Milking