Burton Sneak Preview

UNIT FOUR

572

Clinical Skills and Care

the water to evaporate faster; it will not change the amount of suction. In systems with dry suction, a dial on the drainage unit is set to the suction ordered by the physician, then the unit is con- nected to wall suction. The same amount of suction, –20 cm, is operating, but there is no continuous bubbling and no fl uid that can evaporate. Safety: Be sure you know how to use and evaluate the chest drainage system used in your facility. Chamber Two. The middle chamber (chamber two) is for the water seal. This is required to reestablish negative pressure in the pleural space and to prevent air from entering the cav- ity through the chest tube. It is standard to establish a 2-cm water seal, which means that you will add sterile water up to the 2-cm mark on the middle chamber. Observe this chamber closely. It is not unusual to see the water level rise as the patient inhales and to fall as the patient exhales. This motion, which is referred to as tidaling, will stop when the lung has rein fl ated. Another observation to make about this chamber is that when the patient has a pneumothorax, you will see the air leave the chest cavity and make bubbles in this chamber. Some types of drainage systems have a scale from 1 to 7 mea- suring the amount of escaping air. This allows you to docu- ment the resolution of the pneumothorax. Once the air is removed and the pneumothorax is resolved, you should not see bubbles in the water-seal cham- ber; if you do see bubbles in the water-seal chamber, there is an air leak in the system. Safety: At the first sign of bubbles in the water-seal chamber of a patient with a resolved pneumo- thorax, check all tubing connections and the dressings at the insertion site for possible air leaks. Chamber Three. The remaining chamber (chamber three) on the right is the collection chamber. This is where blood and other fl uids from the pleural cavity are trapped and mea- sured. Because this is a closed system that reestablishes neg- ative pressure within the pleural space, the drainage is never emptied. Rather, you will mark the level of drainage on the writable surface adjacent to the collection chamber. You will also write the date and time, along with your initials, next to the amount of drainage. Then you will determine the amount of output for an 8-hour period. Take the following scenario as an example: When you come on shift, you fi nd the collection chamber contains 325 mL of output counted by the previous shift. Eight hours later, the collection chamber contains 440 mL. To determine the amount of output for your shift, subtract 325 from 440 and record 115 mL as the chest tube output. You should expect the amount of drainage to gradually decrease each day until the pleural space has been drained and the physician removes the chest tube. It is important for you to assess the color and amount of chest tube drainage several times during your shift. Safety: If a sudden increase in total output or a sudden increase in bright red output occurs in

Chest Drainage Systems There are two types of drainage systems for chest tubes. One is a single molded plastic unit containing three cham- bers (Fig. 28.9), and the other is a digital chest tube drain- age system. THREECHAMBER SYSTEM. Chamber One. The chamber on the left (chamber one) is for wet suction. This is used when drainage needs to be gently pulled out of the pleural space. While the drainage unit may be connected to wall suction, the amount of suction is actually controlled by the amount of water in this chamber. Follow the physician’s order for the amount of water to add. You will generally fi ll the chamber to the line marked –20 cm with sterile water. When the suc- tion source is attached, bubbles will be present in this cham- ber, which you will be able to see and hear. Set the suction so that gentle bubbling occurs. Rapid bubbling will just cause

FIGURE 28.9 A chest drainage system with the tubes in the cor- rect position for gravity drainage. Note the taped connections and the three sections of the drainage system. The blue area is the suction chamber, the red area is the water-seal chamber, and the white area is the collection chamber (from Wilkinson JM, Treas LM, Barnett, KL, et al. Fundamentals of Nursing: Thinking, Doing, and Caring. Vol. 2. 4th ed., Philadelphia, PA: FA Davis; 2019).