What are the key points of chest drainage tube care?

A chest drainage tube enters the human chest cavity through a drainage tube to achieve the purpose of expelling gas or liquid from the human body. It can treat some diseases inside the human chest cavity. Post-operative care for the chest drainage tube is very critical. Usually, you should observe the surface of the wound more often and clean it properly to avoid infection of the wound. At the same time, you should also pay attention to whether the drainage tube is normal.

Key points for nursing care of chest drainage tube

1. Keep drainage unobstructed.

2. The length of the drainage tube is appropriate.

3. Do not increase the height of the drainage tube beyond the incision plane to prevent the siphon effect from sucking the liquid in the drainage bottle into the chest cavity.

4. Closely observe the nature and amount of the drainage fluid and record it in detail. For patients with chest infection, observe the color and smell of the drainage fluid. Take antibiotics as directed by your doctor.

5. Replace the drainage bottle once every 24 hours. Pay attention to aseptic operation to prevent gas from entering the chest cavity.

6. If the drainage bottle breaks or the drainage tube suddenly falls off, you should notify the doctor immediately and prepare the necessary supplies to assist the doctor in re-inserting the tube.

Classification of closed chest drainage

1. Intercostal cannula intubation (6-10Fr): generally used to drain pleural effusion, gas accumulation or for rescue. Because of its thin tube diameter and simple operation, it is often used in clinical practice. However, it is not very smooth in discharging thicker fluids such as blood and pus.

2. Intercostal thick tube intubation (20-24Fr): insert a slightly thicker tube through the intercostal space. It is simple to operate and can drain most liquids that are not very viscous. However, this method can easily cause pain if the tube is worn for a long time.

3. Transcostal bed catheterization (28-40Fr): This method removes a small section of ribs and inserts a catheter through the rib bed, allowing a thicker drainage tube to be inserted. And can separate the infected partitions in the chest with fingers or instruments. Therefore, it is suitable for cases with thicker pus and infected septa, and the tube can be worn for a long time. But its disadvantages are greater damage and complicated surgery.

Classification of drainage devices

1. Drainage bag drainage: suitable for catheter drainage, mostly used to drain pleural effusion. The drainage tube is directly connected to a sealed drainage bag. Since the bottle cannot generate negative pressure without a water seal, it is not suitable for cases where there is still air leakage in the lungs.

2. Water seal bottle drainage: suitable for most cases, it can drain air, fluid, blood and pus in the chest.

3. Negative pressure suction drainage with water seal bottle: Because it can increase the negative pressure in the chest, it is suitable for cases with poor lung expansion and large residual cavity in the chest.

Operation method (intercostal tube)

1. Before the operation, a procaine skin allergy test is performed (if lidocaine is used, the test can be omitted), and 0.1 g of phenobarbital sodium or 50 mg of pethidine is injected intramuscularly.

2. The patient should take a semi-recumbent position (if vital signs are not stable, the patient should take a supine position). For drainage of effusion (or blood), the needle is inserted between the 6th and 7th intercostal spaces on the mid-axillary line. For drainage of pneumothorax, the needle is inserted between the 2nd and 3rd intercostal spaces on the mid-clavicular line. The skin of the surgical field is routinely disinfected with iodine tincture and alcohol, covered with sterile surgical towels, and the surgeon wears sterile gloves.

3. Prepare the chest wall in the incision area under local infiltration anesthesia until the pleura and visible effusion or gas are drained out; make a 50cm cut in the skin along the intercostal line, insert the vascular clamp along the upper edge of the ribs, separate the intercostal muscle layers until the chest cavity; insert a drainage tube immediately when fluid or gas is seen gushing out. The depth of the drainage tube inserted into the chest cavity should not exceed 4 to 125px. The chest wall skin incision should be sutured with silk thread, and the drainage tube should be ligated and fixed, and covered with sterile gauze. The end of the drainage tube is connected to a water seal bottle, and the drainage bottle is placed under the bed where it is not easily knocked over.

4. For patients with large amount of air or fluid accumulation in the pleural cavity, drainage should be done slowly. The amount of drainage fluid should not exceed 1000 ml for the first time to prevent rapid swinging displacement of the mediastinum or re-expansion pulmonary edema. After the patient's condition stabilizes, the hemostatic clamp will be gradually opened.