What are the nursing methods for closed chest drainage tube?

Closed chest drainage enters the human chest cavity through a drainage tube, which can discharge toxins or some fluids from the body, promote the human lung tissue to reach an active state, and treat some chest diseases. Timely care is required after the closed chest drainage tube is placed. Keep the wound clean to avoid infection. Pay more attention to whether the drainage tube is leaking.

Nursing of closed chest drainage

1. Maintain the airtightness of chest drainage: Since there is negative pressure in the chest cavity, in order to prevent the drainage fluid from flowing back and causing retrograde infection, ensure that the plane of the patient's chest drainage bottle is at least 60 cm lower than the plane of the chest drainage port. Advise the patient not to lift the drainage bottle too high when moving, and not to cross the bed. The drainage tube should not be too long to prevent it from folding. To prevent the chest tube from communicating with the outside world, when replacing the drainage bottle, the tube must be clamped in both directions with a pair of forceps; to prevent the pipeline connection from being loose or the drainage bottle from tilting to the point where the water seal tube is exposed above the water when the patient goes out for examination, the tube should be clamped with two pairs of forceps in different directions. If the forceps have teeth, the teeth should be wrapped with gauze or rubber sleeve to prevent the drainage tube from rupturing or leaking when clamping the tube.

2. Maintain the patency of chest drainage:

(1) Observe the fluctuation of the water column in the drainage tube: The fluctuation of the water column can not only observe the patency of the chest drainage, but also reflect the degree of lung expansion. During normal calm breathing, the water column fluctuates from 3 to 250px, while during coughing and deep breathing, the fluctuation range can increase to 12 to 400px. For patients with large residual cavity in the chest cavity, the water column fluctuates greatly, sometimes up to 500px, and even the liquid in the water seal bottle will be sucked into the liquid storage bottle. As the remaining lung expands, the residual cavity becomes smaller, and the negative pressure gradually decreases. When the water column fluctuation is only 2 to 4 cm or there is a slight fluctuation, extubation can be considered. The larger the range of water column fluctuation, the larger the residual cavity in the chest cavity and the poor expansion of the lungs. The gradual disappearance of water column fluctuations is one of the important indications for drainage tube removal; when the water column fluctuations suddenly disappear, it may be that the tube is blocked or obstructed.

(2) Squeeze the drainage tube regularly to ensure that it is unobstructed: When the drainage fluid is bloody, the tube needs to be squeezed once every 1-2 hours. During the operation, hold the drainage tube with both hands at 10 to 15 cm, connect both hands front and back, with the palm of one hand facing up and close to the chest wall, place the drainage tube between the fingertips and the thenar eminence, and use the other hand to block the drainage tube 4 to 5 cm away from the lower end of the front hand. The front hand squeezes the drainage tube quickly and forcefully with high frequency, and then releases both hands at the same time, using the liquid or air in the drainage tube to flush out the blood clot or tissue mass blocking the drainage tube, and repeat this process. Or use talcum powder to smooth the tube: apply talcum powder on the surface of the chest tube, hold the upper end of the chest tube with your right hand, hold the chest tube from top to bottom with your left hand, and slide it down to the lower end of the chest tube, then release your right hand. This method can increase the negative pressure of the chest tube and drain out less solid blood clots or coagulated fibrin.

3. Observe the gas discharge from the drainage tube. Air leakage can be divided into three degrees: when the patient coughs hard and holds his breath, bubbles are discharged from the drainage tube, which is degree I; when the patient takes a deep breath and coughs, bubbles are discharged, which is degree II; when the patient breathes calmly, bubbles are discharged, which is degree III. Grade I-II air leakage can heal itself after 2-5 days; Grade III can gradually turn into Grade II or Grade I and heal itself after 5-7 days. If there is a large bronchial fistula or stump fistula, there will be persistent Grade III air leakage and bleeding or infection signs, which require separate treatment.

4. Care of continuous negative pressure suction closed chest drainage: Generally, the negative pressure suction of closed chest drainage after thoracotomy should exceed the end-inspiratory chest negative pressure by 5-250px. If the patient has poor lung elasticity, a long compression time, or a thin fibrous membrane covering the lung surface making it difficult for the lung to re-expand, or if the patient has continuous air leakage from a segmentectomy lung section, or has pneumothorax, the negative pressure can be appropriately increased to 10-375px. Negative pressure suction should be initially set at a low negative pressure level and slowly fine-tuned according to the patient's condition. During negative pressure suction, the changes in chest pressure should be closely observed, and the patient should be closely observed for chest tightness, shortness of breath, cyanosis, increased bloody drainage fluid, etc., to determine whether the trachea is centered and whether the breath sounds of both lungs are symmetrical by auscultation. Negative pressure suction should generally be started 24 hours after surgery to prevent intrathoracic bleeding. In clinical work, do not adjust or interrupt negative pressure suction at will to prevent the recruited alveoli from collapsing again.

5. Prevention of infection: All operations should be carried out under aseptic conditions. When changing bottles and removing the connecting pipes, they should be wrapped with sterile gauze. The drainage tubes, connecting pipes and drainage bottles should be kept clean and rinsed with sterile distilled water regularly. The water seal bottle should be located below the chest and should not be inverted. The drainage system should be kept closed and the joints should be firmly fixed to prevent intrathoracic infection.

6. Indications for extubation: 48-72 hours after closed chest drainage, if the drainage fluid is less than 50 ml, there is no gas overflow, the chest X-ray shows lung expansion or no air leakage, and the patient has no dyspnea or shortness of breath, extubation can be considered. When removing the tube, instruct the patient to take a deep breath, remove the tube quickly at the end of inhalation, seal the wound with vaseline gauze, and bandage it to secure it. After extubation, observe the patient for chest tightness, dyspnea, incision leakage, exudation, bleeding, and subcutaneous hematoma.