Definition
It refers to the replacement of existing intercostal drainage bottles with a new one using aseptic technique.
Purpose
To maintain and enable the system to continue functioning effectively.
Indication
- Disconnection of the tube
- Broken container.
- To empty the bottle when it is full.
Articles
- Clean trolley.
- Sterile dressing set.
- Chest drainage bottle holder.
- Sterile gloves.
- Sterile chest drainage bottle with two- or three-way cork.
- Clean mask.
- long and short tubes (plastic/glass).
- Waterproof adhesive tape.
- Sterile water or sterile normal saline.
- Scissors.
- Sterile pint measure (optional).
- Clean clamps (2 Nos. tips covered with rubber).
- Receptacle for soiled disposable items.
Procedure
| Nursing Action | Rationale | |
| 1 | Before procedure Check physician’s order and nursing care plan for specific instructions. | |
| 2 | Identify the patient and explain procedure to the patient and relatives. | Allays fear and gains patient’s confidence and cooperation |
| 3 | Assess vital signs. | Provides baseline to compare with changes after procedure |
| 4 | Assemble equipment | Saves time and energy. |
| 5 | Provide privacy. | |
| 6 | During procedure Wash hands and don sterile gloves. | |
| 7 | Prepare chest drainage bottle: For one-bottle system Open a sterile two-way bottle and add sterile water. Ensure that the distal end of the long tube is immersed in 2-3 cm of water.Mark the water level in the bottle. Insert long and short tubes through the two-way cork into the bottle for two-bottle system In case of two-bottle system the first bottle is used to collect fluid and air from pleural space and the second bottle serves as water seal chamber. To change these bottles: Prepare the water seal chamber as mentioned above. Prepare another empty, sterile, two-way bottle with two short tubes. Connect the two bottles Three-bottle system: In case of three-bottle system, the first bottle is used to collect fluid and air from pleural space, the second bottle serves as water seal, and the third bottle is to control the amount of suction applied. Prepare the first and second bottles as in two bottle system. Add 20 cm of sterile water in the third sterile bottle. Insert two short tubes and long tube through the three-way cork into the bottle. Connect the bottles as shown in. | The depth of tube submersion determines the amount of suction |
| 8 | Ensure that bottles are kept in the bottle holder. | Prevents risk of accidental breakage. |
| 9 | Place the patient in a comfortable sitting position | Enables free access to the site. |
| 10 | Clamp the intercostal drainage tubing by using two clamps. One clamp is positioned 1% to 2% inches from insertion site and the second clamp is placed one inch down from the other one. | Prevents air entering into pleural cavity |
| 11 | Disconnect old bottle/bottles from the chest tube. | |
| 12 | Reconnect new bottle/bottles as shown in figure. | |
| 13 | Maintain bottle/bottles at 0.5-1 m below the patient’s chest. | Prevents water being sucked into the chest |
| 14 | Release clamps from chest tube. | Prolonged clamping may lead to the development of tension pneumothorax. |
| 15 | Watch for repeated fluctuation in the water level in the distal end of chest tube (tidaling). | These fluctuations correspond to the patient’s breathing and indicate that the system is patent. Absence of fluctuation indicates that the chest tube is blocked, or the lung is re-expanded. This can be confirmed by percussion, auscultation and chest radiography. |
| 16 | Loosely fasten the chest drainage tube to patient’s clothing | Prevents dragging of the chest tube. |
| 17 | After procedure Position patient comfortably on the bed. | |
| 18 | Wash and dry hands. | Prevents transmission of infection. |
| 19 | Record procedure. | Acts as communication among staff members. |
| 20 | Continue monitoring the patient. | Helps to know the response to new system |
Special consideration
- Milking or stripping the chest tube is controversial as it may create excessive negative pressure, so it is not recommended nowadays.
- Extra set of sterile containers and connection should always be available.
- Regular, frequent, staged coughing and deep breathing are important since they increase the intrapleural pressure and force air and fluid to drain out of the cavity and thus promoting lung expansion.
- Drainage exceeding 100 mL/h or a change in drainage to a bright red color indicates fresh bleeding and requires immediate notification to the physician.
- Always keep two clamps near bedside, to use in case of accidental disconnection or breakage of system.
- In case of accidental breakage of bottles, the tubes should be immersed in a bottle with sterile saline or sterile water.
- If there is accidental displacement of chest tubes, nurse should cover the site with a sterile Vaseline gauze pad.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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