Chest Tube System Setup (Nursing)

00:04 Let's take a look at the skill chest tube system set up.

00:07 So before we get much further, let's talk about the chest tube itself.

00:11 So when this is placed, it can be placed by the physician at the bedside, maybe interventional radiology or the operating room.

00:20 So just one thing to know is that we do not insert a chest tube as a nurse, this is going to be advanced practice provider or physician.

00:28 However, sometimes when the chest tube is set up, they definitely can do this at the bedside to the safety of the patient.

00:33 And we may have to set up the system and the drainage for a patient.

00:37 So let's take a look at that.

00:40 So let's look at the equipment we're going to need, we're going to need the chest tube collection unit and which whatever the preferences of the physician.

00:48 We're going to need the sterile water.

00:50 Luckily, usually this comes on the back of the system itself and it's attached to the system and in the package.

00:56 We need our section setup, we also need some tape to secure the tubing.

01:01 And before we start anything, always perform your hand hygiene.

01:04 We want to make sure we provide privacy for our patient and really explain this procedure to the patient.

01:10 Okay, this chest tube itself, the insertions really scary, and hopefully that's been thoroughly explained.

01:16 Typically, as a nurse, you may be with a patient when this happens.

01:20 We're also going to talk to them about the equipment and the setup as well.

01:25 Now let's make sure we put on our gloves and open the chest tube collection system.

01:31 Now we can remove the sterile water that comes with the system.

01:35 So this is usually neatly packaged in the back of the actual system itself.

01:41 Now we're going to use that sterile water and fill the wet suction chamber to the specified level.

01:47 Now we also want to use sterile water to fill the suction control chamber to the specified level.

01:52 If you remember, this is usually at about a -20.

01:55 And there will be marks for you to look at that.

01:58 Now once that chest tube is inserted into the patient, we want to use a non-touch method.

02:03 And we want to make sure we don't touch the end of the chest tube and the connection and make sure we keep those sterile, the sterile ends.

02:11 Now we want to secure the connection using tape, we just want to make sure this connection does not get loose, because this can cause problems for our patient.

02:19 Now it's important to ensure the tubing is connected to the drainage collection system.

02:25 And you can see on this image there's a couple of different ports, and it's labeled nicely for you on these systems.

02:31 Notice there's the suction port.

02:33 Also there's the port for the patient.

02:35 So don't worry about getting these confused.

02:37 These are nicely labeled for you as the nurse on the system itself.

02:42 Now if suction is ordered, we need to adjust the suction so that gentle bubbling in that wet suction device is noted.

02:50 So again, if you remember, on a wet suction, we're going to do suction via water and there will be some gentle bubbling there.

02:57 So now let's take a look at the dry suction device.

03:01 So remove the sterile water from the chest tube drainage system.

03:04 And if you remember, this is typically attached to the drainage system itself.

03:10 Now we're going to take some sterile water, fill the air leak chamber to the specified level, and there's typically a nice really clear dotted line of where you fill that to.

03:20 Then we're going to make sure we take that little dial the dry suction and turn it to whatever the correct level suction is going to be.

03:27 Now remember, we need to check our physician order and see what level it should be.

03:32 Typically it's going to be -20.

03:35 Now once the chest tube is inserted by the physician or the advanced practice provider, you're going to use that non-touch method to attach the tubing.

03:43 Now if you remember, each part of this is sterile, so we want to be really careful here.

03:48 So we want to use sterile technique when we're attaching the tubing system to the drainage system.

03:53 We really want to secure this with tape because we do not want to get that connection loose.

03:59 And ensure that tubing is connected to the drainage collection system.

04:03 And just like the wet, notice there's 2 suction there's a valve for that and for the patient.

04:08 So it's really nicely labeled for you so you don't mix up the tubing.

04:14 Now on the dry section to validate that suction is working, we're going to look at that orange bellow and make sure it's expanded at or beyond that indicator mark.

04:27 Now after we've talked about and set up both systems, let's take a look at a few things we need to look at post procedure.

04:33 So we want to place the drainage system below the level of the patient's chest.

04:38 This is really important, it should always be below the level of the patient's chest.

04:44 Now you need a place to put the drainage system.

04:46 Well this can hang on the bedside with the hangers that come on the system.

04:50 Or if need be, the system also has some really handy foot stands for stability.

04:56 You can use these as well if they need to be sitting on the floor.

05:00 Now make sure you trace your tubing and that's free of kinks.

05:04 And you also at this point can remove your gloves, perform your hand hygiene and make sure you document the procedure thoroughly.

05:12 We just looked a lot at system setup.

05:15 So let's take a moment and talk about a really important question.

05:18 What part of the chest tube setup is sterile? I may give you a few moments to think about that.

05:31 Okay, answer is the actual inside of the unit.

05:36 That's why the sterile water that actually comes on the back of the unit to make you remember, "Hey, use sterile water here, not tap." Also, don't forget that connecting the drainage system to the chest tube on the patient is definitely sterile.

05:51 Now if you think about the chest tube, where's that coming from? That's coming from the thoracic cavity of the patient and we definitely want to keep that sterile.