Introduction to Chest Tubes and Drainage Systems (Nursing)

00:04 Hi, guys, welcome to the topic of Chest Tubes.

00:07 So this is a really overwhelming topic for some.

00:10 But if you'll hang with me, we're going to talk about some really important concepts to help you take care of these type of clients.

00:18 So first of all, why do we even need a chest tube? Well, there's some really important things.

00:23 So first of all, it can remove air, it can remove fluid and blood from the space lining the lungs, or the space between the lung and the chest wall.

00:35 So how does this even happen? Well, this can happen from infection, lung disease, cancer, or surgery, and especially biopsies.

00:47 So another thing to remember about a chest tube, it can help create a negative pressure, and it'll help the lung reinflate.

00:54 So how does this happen? Well, if you think about if someone gets trauma, for example, like a motor vehicle accident, or a penetrating chest wound like a knife, or a gun shot, while we're poking, basically like a hole in a balloon, and that balloon can shrink, that chest tubes really going to be pivotal to help reinflate.

01:13 So one other important note before we get too far is that chest tube may or may not be connected to suction.

01:20 So sometimes we need that extra suction to remove fluid and sometimes we can just allow it to drain by gravity.

01:27 So just key note that a healthcare provider will order the amount of suction as ordered.

01:32 So always notice, if you are going to do suction, there will be a specific amount of suction that's order, so make sure you check that.

01:42 So we just talked about some really pivotal uses on chest tubes.

01:45 So now let's talk about placement.

01:48 Well, let's take a minute to look at this image that we see here.

01:51 So you see in blue, this is the patient's lungs that you're looking at.

01:55 Also, do you see that white cage look, that is going to be your rib cage.

02:00 So when we talk about intercostal spaces, before we move on, I want you to note that word.

02:06 When we talk about intercostal, this just means the spaces between two ribs.

02:11 So if you're looking at this image, and you see where that little bitty tubes going through, you see there's one rib, a space and another rib, the space in between those two ribs, again, are your intercostal spaces.

02:24 And this is typically where the chest tubes inserted.

02:27 So when we're talking about placing a chest tube, and we need to remove air, you're typically going to see it up higher.

02:33 So think about air high to the sky and your chest tubes higher, such a great cheat.

02:38 So you can see here with the chest tube to remove air, it's about the second intercostal spaces where you're going to see that.

02:46 Now on the other side, on the other tube, you see it's much lower.

02:49 So think about draining to gravity or draining fluid.

02:53 Now this is much lower on the rib cage.

02:55 And you're typically going to see this about the fifth or sixth intercostal space.

03:00 So now let's look at the drainage system itself.

03:03 This system alone has come a long way.

03:06 So note that this is a single self-contained unit.

03:09 Now you will see some variations on this, your physician may have a preference.

03:13 Now your facility may have a preference.

03:15 So just be familiar with the one that your facility uses.

03:19 But we're going to walk you through some commonalities and some variations on these systems.

03:25 So first, almost all systems are going to have a suction control chamber.

03:29 This is important because it regulates the amount of suction and also helps facilitate drainage.

03:36 And systems are going to have an air leak monitor.

03:39 This one's really important to get to know and pay attention to because if there's an air leak in the system, that can be a really bad complication and a problem for your patient.

03:49 And don't forget the collection chamber.

03:51 Now this is where all the drainage is going to accrue and we need to monitor this closely.

03:57 So let's take a moment to look at some really common units that you're going to see on the floor.

04:02 You may see a wet suction device or a dry suction device.

04:05 Again, it'll be surgeon or facility preference.

04:08 So let's take a look at some of the things that are the same and some that are different.

04:13 So if you see 1a here on the wet suction side, notice that there's a level of water there.

04:19 That is how these sections control through the wet suction device.

04:23 Now let's compare that to 1b.

04:25 So notice there's a really nice pretty dial there for you.

04:28 It's got numbers such as -10, -20.

04:31 It makes it really easy to figure out what suction method or what pressure that I needed that.

04:36 So that's the comparison about the suction.

04:39 Now let's take a look at the air leak monitor number 2.

04:42 Nice thing these things are the same, right? You see that level of water.

04:46 Here is where we're going to be able to determine if there's an air leak in our system.

04:51 If there's an air leak, this is a problem and we need to call our doctor.

04:55 So again, air leak monitor the same in each one.

04:58 Same thing with the collection chamber, notice that there's little increments is marked for levels on output for us, which is really nice because we can see how fast that drainage is accumulating in our collection chamber.

05:12 Now, if you see on number 4 here, both have a water sealed chamber and they work as a one way valve on these systems.

05:19 Now one thing to know, do you see on the dry suction side number 5, you see that 5 marker and that little orange bellow is what we like to call it.

05:28 This is really helpful because this is a suction indicator, and lets us know if the suction is working properly or not.

05:35 Now we talked a lot about the components of those chest tube.

05:38 Now let's look at some troubleshooting tips for nurses.

05:42 Now specifically, let's talk about air leaks and the correct suction.

05:47 Now, if you see this image here, okay.

05:49 What is this called? Do you remember? This is the air leak monitor.

05:53 So as a nurse, if we're looking at this, what should we do? Is this good? Is this bad? What do you think? All right, so if you see continuous or intermittent bubbling in this section, this is something that we are concerned, there may be an air leak, hence the name air leak monitor.

06:12 Now clearly, there's going to be severities of air leaks, right, so we need to think about this.

06:17 So if you see bubbling, that's moving from the right closer to that one number to the left, that's going to be the indicator for the severity of the air leak.

06:27 So there may be a situation where your patients may be coughing, for example, and maybe their air leak is at maybe a 1-2, that may not be an issue, but we need to call the doctor and confirm this.

06:38 Now you can imagine if that bubbling is going all the way to the left, maybe at the 3, 4 or the 5, that could indicate a severe air leak, and we need to trace our lines, contact our doctor.

06:51 Now let's look at the suction.

06:53 If you remember, this is a little different depending on the system.

06:56 So let's look at the wet side.

06:58 So here we have a wet suction unit.

07:00 So what's really important to know if you remember what in water that the suction is controlled by water.

07:07 So it's really important to make sure that the height of the water is at the appropriate level.

07:13 And again, -20 is what you're typically going to see for suction.

07:17 So I know we just talked about air leaks, I don't want to freak you out.

07:21 But in the suction control chamber, you will see some gentle bubbling in this.

07:26 This is how we know the suction is working.

07:29 So don't let that alarm you.

07:30 So where should that air bubbling be in the suction control chamber, not the air leak monitor.

07:37 Now let's take a look at the dry suction.

07:40 If you remember earlier, this one's a lot different, right? We've got this great dial and it's got -20, -10, -30.

07:47 It's really easy to see that we're at the appropriate suction level here.

07:51 But if you mere see that little orange thing on the bottom, that's what we call the bellow.

07:57 So the bellow should be expanded past the indicator mark so this is going to let us know that the suction is working properly.

08:04 So don't get too hung up that that bellow was right at that arrow.

08:08 It just should be expanded at or maybe even a little pass that marker beyond.