CARE OF CHEST DRAINAGE

INTRODUCTION
Chest drainage is one of the crucial interventions for improving gas exchange and breathing.
After thoracic surgery, chest tubes and a closed drainage system are used to re- expand the
involved lung and to remove excess air and fluid. A chest drainage system must be capable of
removing whatever collects in the pleural space so that a normal pleural space and a normal
cardio pulmonary function may be restored and maintained.

DEFINITION
Inter costal water seal drainage system is insertion of tubes into the pleural cavity with attached
drainage system so as to remove air, blood or fluid from the pleural cavity using water in a
closed bottle acting as a one way valve permitting the unidirectional flow of air or fluid out of
the pleural space.

PURPOSE
 Inter costal drains or chest tubes are inserted through the thorax to remove air and fluids
from the pleural space, to prevent air or fluid from re- entering it.
 It promotes re-expansion of lung.

INDICATIONS
 Pneumothorax
 Hemothorax
 Thoracotomy
 Chest surgery
 Chest trauma

PRINCIPLES
 Gravity – fluid flow from a higher level to a lower level. Therefore, always keep the
chest drainage apparatus below the level of the person’s chest.
 Positive pressure- air or fluid in the chest cavity creates positive pressure in the pleural
space

PREPARATION OF ARTICLES
ARTICLES RATIONALE

1. Sterile chest tube To water seal drainage.

2. Gown, mask, cap & gown Maintain asepsis
 3. Syringe + needle for local anesthesia To keep the patient pain free
4. Lignocaine 2% The local anesthesia used.
5. Betadine gauze For cleaning the area.
6. Adhesive plaster, tincture benzoin To seal the wound and adhere it.
7. Mackintosh with towel or plastic sheet To prevent bed linen from getting spoiled.
8. screen To provide privacy

PROCEDURE
Steps Rationale
1. Wash hands. To prevent from infection.
2. Explain the procedure to the patient. Help reduce anxiety and get the patient’s co-
operation.
3. Collect the all articles and bring to the For ease in procedure.
bedside.
4. Keep the patient in fowler’s position. For optimal drainage.
5. Assist the surgeon with insertion of To prevent delay in intervention.
chest tubes.
6. Connect chest tubes to water seal Water seal drainage provides for the escape of
drainage air and fluid into a drainage bottle. Water acts as
a seal and keeps the air from being drawn back
into the pleural space. Water displaces when air
is added.
7. Assess the client for respiratory distress To check effectiveness of procedure. To prevent
and chest pain. complications.
8. Observe the following-
 Chest tube dressing. Ensures that dressing remains occlusive and
notes any discharge.
 Tubing for kinks, dependent loops or Maintains a patent , freely draining system
clots. preventing fluid accumulation in the chest cavity.
System can function effectively and back flow is
 Chest drainage system should be prevented.
upright and below the level of the
insertion. Fluid rises on inspiration and falls with
 Water seal for fluctuations with the expiration, indicating proper functioning of the
patient’s inspiration and exertion. system.
 Bubbling in water seal bottle/ Bubbles are indicators of air coming out of the
chamber. intra pleural space. Ensure proper functioning of
the system.
 Record color and amount of drainage Re-expansion of lungs forces drainage out into
and follow up, care after the initial the tube. Evaluates drainage.
connection.
9. Ensure drainage tube in water seal 2.5 If the tube is not deep enough, there is a danger
cm below the water level. of air from the bottle entering the intra pleural
 space. Normal negative pressure in intra pleural
space allows air entry.
10. Establish original level of fluid by This provides a baseline for the measurement of
marking with pen/ tape. Filling to a fluid drainage. Evaluates drainage amount.
present amount.
11. Ensure that 2 tubing clamps are always In the event of accidental disconnection of the
at the patient’s bedside. drainage tubing from inter pleural drain.
12. Maintain a high fowler’s or medium Permits optimal drainage of air/ fluid.
fowler’s position.
13. Maintain all connections between chest Secure the chest tube to the drainage system and
and drainage tubes intact and taped. reduce risk of failure of an airtight system.
Prevents air leaks.
14. Coil excess tubing on the mattress next Prevents pressure of tubing on the suture and the
to the patient. patient’s body. Avoid discomfort to the patient
15. Wash hands. Minimizes risk of infection.

AFTER CARE OF PATIENT

 Stay with the patient till he/ she is at ease.

 Keep the patient warm and comfortable.
 Provide an analgesic, if required.
 Observe vital sign and drainage.
 Record procedure with date and time.
 Check that chest wall wound is sealed well.
 Take all the used articles to the utility room. Send drainage bottles for re- sterilizing.
 Take chest x-ray after tube removal.

SCIENTIFIC PRINCIPLES
1. ANATOMY & PHYSIOLOGY
 The respiratory tract consists of nose, pharynx, larynx, trachea, bronchi & lungs.
 The chest cavity is lined with a serous membrane, which exudes a thin fluid.
 The pleural cavity is the potential space between the two pleurae (visceral and
parietal) of the lungs.
2. MICROBIOLOGY
 The nurse must wash her hands before & after procedure to prevent cross
infections.
 The intact skin is impassable barrier to microorganisms.
 All equipment used for the care should be clean. Separate articles may be kept for
individual patient to prevent cross infection.
 3. PHYSICS & CHEMISTRY
 Chest drainage system should be upright and below the level of tube insertion.
 Re- expansion of lungs forces drainage out into the tube.
4. PSYCHOLOGY
 Relieve the anxiety of the patient by explaining what the procedure is, what she is
going to do.
 Provide privacy by screening.
 Nurses should do her work as skillfully as possible so that her power has been
done to give the patient comfort & relief.

NURSING RESPONSBILITY
 Check all tubing connections and re- tape as needed.
 Monitor for air leaks and oxygen saturations.
 Inform patient about all procedures and needs for better cooperation.
 Make patient comfortable with adequate support.
 Patient is kept on bed rest.
 Record details of fluid and any complaints.
 Evaluate patients after procedure.
CONCLUSION
Closed chest drainage is commonly used after chest surgery. It is also used to treat hemothorax
and pneumothorax. It is essential to be knowledgeable about closed chest drainage systems
before caring for people requiring them. The chest tube is connected to a closed chest drainage
system, which allows for air or fluid to be drained.
 BIBLIOGRAPHY

1. Smith Evans Pamela Taylors (2005) Clinical Nursing Skills – A nursing Process Approach
(1stedi.) New York, Lippincot Williams Wilkins.    

2. Jacob Annamma & et al. (2007) Clinical Nursing Procedure the art of Nursing practice
(1st Edition) New delhi, Jaypee Brothers.

3. Lillis Carol & et al. (2001) Foundation of Nursing art & Science of Nursing Care (4th
edition) New York, P.P. Lippincott.

4. Rosdahl Bunker Caroline & Kowalski T. Many (2002) Textbook of basic Nursing (8th
edition) New York, Lippincott

5. Corea C. C (2010) Principles &Practice of nursing (2nd edition) new delhi.

6. Kaur lakhwinder (2011) fundamental of nursing(2nd edition ) new delhi.

7. Clement I (2007) Basic concepts on Nursing procedures (2nd edition) New delhi, Jaypee
Brother.

8. Nancy sr. (2013) Principles & practice of nursing (6th edition) Indore, N.R. publishing house
 JABALPUR INSTIUTE OF NURSING
SCIENCES AND RESEARCH
SUBJECT ON –NURSING EDUCATION
PRACTICE TEACHING ON
CARE OF CHEST DRAINAGE

Submitted To Submitted By
Mrs. SURBHI R.KEHaRI miss PREETI SHARMA
Professor M sc (N) 1st year
Jinsar Jinsar