Question

Chest Tube Management You have been assigned a post-operative cardiac patient with a chest drainage tube inserted mediasternally. List the important considerations in managing a chest drainage system (20-40 words)

4.1) Position of client and the drainage system

4.2) Observations

4.3) Insertion site care

4.4) Patency for drainage system

4.5) Exercise

4.6) Contingencies/ Emergencies e.g. client pulling the tube out

Answer 1

4.1)The patient has to be placed in a semi-Fowler position to aid draining and the drainage system should be below chest level to drain fluid with gravity.

4.2)Observe the following

• Air leakage (presence of bubbles In the chamber)
• Any kinks in the tube which may interrupt draining
• Observe for signs of infection, bleeding,wettnes,leakage,pain
• Maintain water seal at 2cm
• Observe heart rate,blood pressure,oxygen saturation and respiratory rate

4.3)The insertion site care are as following

• Change the dressing when soiled or wet
• Strict aseptic dressing is advised to prevent infection
• Make sure the sutures are intact

4.4)The patency for drainage is a clog free or kink free which enables to assess the quantity or the volume of the drainage

4.5)Exercise

• Patient can be ambulated if capable or a physiotherapy is provided
• Deep breathing exercise is adviced
• use of spiromwtry is encouraged

4.6)Contingency

• Accidental removal is possible, apply pressure with sterile gauze immediately and do a tight dressing from air leakage
• Monitor patient's vitals and inform the concerned physician
• Activate CPR code if needed and cell for help