It is important to know if the drainage system should be hooked up to continuous wall suction or water seal. Also, confirm that suction control is dialed to correct pressure, and the drainage system is kept below the level of the chest.
Crepitus occurs when gas or air leaks into the subcutaneous layer of the skin, which is a phenomenon also called subcutaneous emphysema. This can indicate an air leak or the need for a dressing change. Notify the doctor if crepitus is felt.
The water in the water seal chamber should oscillate; specifically, the level will move up during inhalation and move down during exhalation. When there is no oscillation in the chamber, check the line for kinks.
Assess the patient’s respiratory status regularly, and auscultate lung for any sound changes. Any clinical changes, such as the development of shortness of breath can indicate a functional problem. Air leaks, an extended pneumothorax, or a hemothorax can put the patient in respiratory distress.
Keep the dressing clean, dry and intact. Monitor vital signs for acute changes, as well as the site of chest tube placement for evidence of infection. If the dressing becomes soiled, change the dressing per hospital policy.
Excessive bubbling in the water seal chamber indicates an air leak in the system. Regularly assess the system for possible causes or leaks. However, gentle intermittent bubbling should be expected with patients that have known pneumothorax.
If the chest tube dislodges from the patient, the insertion site should be covered with sterile occlusive dressing taped on 3 sides.
In the event that the drainage system breaks, it is critical to have a bottle of sterile water at the bedside. If this happens, insert the loose end of the patient's chest tube into a bottle of sterile water. Keep the bottle below the level of the chest until a new drainage system can be delivered.
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