How to Use a Chest Drainage Tube: Step-by-Step Guide
How to Use a Chest Drainage Tube: Step-by-Step Guide
A chest drainage tube is a medical device used to remove air, blood, or fluid from the pleural cavity, typically after surgery or trauma, to help the lungs re-expand and restore normal breathing. Proper placement and use of a chest drainage tube are critical to ensuring successful outcomes and minimizing complications. Below is a step-by-step guide on how to use a chest drainage tube.
1. Preparation and Equipment Check
Before inserting the chest drainage tube, ensure you have all the necessary equipment and supplies:
- Chest drainage tube (appropriate size and material)
- Sterile gloves and drapes
- Local anesthetic (such as lidocaine)
- Surgical instruments (scalpel, scissors, forceps)
- Syringe (for anesthetic injection)
- Collection chamber or drainage system
- Sutures (to secure the tube)
Ensure all tools are sterile and that you are working in a clean and safe environment.
2. Patient Positioning
Position the patient correctly for the insertion of the chest drainage tube. The common position for chest tube insertion is in the supine or semi-recumbent position, with the arm on the affected side raised above the head to expose the intercostal spaces. This helps to maximize access to the chest cavity.
3. Marking the Insertion Site
Identify the appropriate location for tube insertion. Typically, the chest drainage tube is inserted in the 5th intercostal space (mid-axillary line) for fluid drainage or in the 2nd intercostal space (midclavicular line) for air evacuation (e.g., in pneumothorax cases). Mark the site with a pen or sterile marker.
4. Administering Local Anesthesia
Clean the insertion site with an antiseptic solution and administer a local anesthetic to the area. For patient comfort, make sure the entire area is numbed, including the skin, subcutaneous tissue, and pleura, if needed. Wait for a few minutes for the anesthetic to take effect.
5. Insertion of the Chest Drainage Tube
Once the anesthetic has taken effect, use a scalpel to make a small incision at the marked site. A typical incision is around 1–2 cm long.
- Insert a blunt dissection instrument (e.g., curved forceps) to gently open the intercostal muscles and access the pleural cavity.
- Once the cavity is reached, insert the chest drainage tube through the incision, directing it towards the pleural space. The tube should be advanced carefully to avoid injury to surrounding structures, such as the lungs, heart, and diaphragm.
- If draining air (for pneumothorax), the tube should be positioned in the upper part of the pleural space. For fluid drainage, position the tube in the lower part of the pleural cavity.
6. Connecting the Chest Drainage Tube to the Drainage System
After inserting the tube, connect the distal end of the chest drainage tube to a drainage system. This system will typically include:
- A suction control chamber (for suction if needed)
- A water-seal chamber (to prevent air from flowing back into the pleural space)
- A collection chamber (to collect the fluid or air drained from the pleura)
Make sure the tube is securely connected to the drainage system and there are no leaks at the connection site.
7. Securing the Chest Drainage Tube
Once the tube is in place, secure it with sutures or sterile adhesive dressings to prevent it from becoming dislodged. It is essential to ensure that the tube remains in place during the patient’s recovery. Additionally, ensure the tube is properly taped to the skin to minimize movement and reduce the risk of accidental dislodgement.
8. Monitoring and Observing
After the chest drainage tube is inserted, monitor the patient closely for any signs of complications. Important parameters to observe include:
- Drainage output: Monitor the amount and type of fluid draining into the collection chamber. Clear fluid typically indicates normal drainage, while blood or pus may indicate complications.
- Respiratory status: Keep track of the patient’s breathing pattern, oxygen saturation, and lung sounds. Improvement in breathing or a reduction in dyspnea (difficulty breathing) indicates that the drainage is effective.
- Positioning: Ensure that the drainage tube remains in place and that the patient’s positioning doesn’t compromise the tube’s function.
9. Removing the Chest Drainage Tube
Once the drainage output decreases and the lungs have re-expanded (as confirmed by imaging or clinical assessment), the chest drainage tube can be removed. This typically occurs after a few days, depending on the patient’s condition. The tube should be removed carefully, and a sterile dressing should be applied to the site to prevent infection.
10. Post-Insertion Care
Once the chest drainage tube is removed, monitor the patient for any signs of complications, such as pneumothorax, bleeding, or infection at the insertion site. Perform follow-up imaging (e.g., chest X-ray) to ensure proper lung expansion and no recurrence of the problem.
Conclusion
The chest drainage tube is an essential tool in managing various conditions like pneumothorax, pleural effusion, and post-surgical recovery. Proper insertion, management, and monitoring of the chest drainage tube are crucial to patient recovery and preventing complications. Healthcare professionals should follow the correct procedures to ensure optimal outcomes and improve patient comfort during this critical phase of care.
