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    ICU One Pager Chest Tubes

    Uploaded by

    Mohamed Mahmoud
    This document provides a step-by-step assessment of chest drain function including tube positioning, drainage output, tidal flow, air leaks, and weaning from the chest drain. It describes the key components of an underwater chest drain system including drainage, a one-way valve, and pressure regulator. Modern chest drain systems function similarly by collecting and quantifying fluid drainage while allowing air to escape from the thorax if pressure rises above a certain level. Factors like tube size, positioning, suction level, and resolving the underlying issue determine when a chest drain can be removed.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    ICU One Pager Chest Tubes

    Uploaded by

    Mohamed Mahmoud
    100 views1 page
    This document provides a step-by-step assessment of chest drain function including tube positioning, drainage output, tidal flow, air leaks, and weaning from the chest drain. It describes the key components of an underwater chest drain system including drainage, a one-way valve, and pressure regulator. Modern chest drain systems function similarly by collecting and quantifying fluid drainage while allowing air to escape from the thorax if pressure rises above a certain level. Factors like tube size, positioning, suction level, and resolving the underlying issue determine when a chest drain can be removed.

    Original Description:

    Once on chest tubes

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    This document provides a step-by-step assessment of chest drain function including tube positioning, drainage output, tidal flow, air leaks, and weaning from the chest drain. It describes the key components of an underwater chest drain system including drainage, a one-way valve, and pressure regulator. Modern chest drain systems function similarly by collecting and quantifying fluid drainage while allowing air to escape from the thorax if pressure rises above a certain level. Factors like tube size, positioning, suction level, and resolving the underlying issue determine when a chest drain can be removed.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    100 views1 page

    ICU One Pager Chest Tubes

    Uploaded by

    Mohamed Mahmoud
    This document provides a step-by-step assessment of chest drain function including tube positioning, drainage output, tidal flow, air leaks, and weaning from the chest drain. It describes the key components of an underwater chest drain system including drainage, a one-way valve, and pressure regulator. Modern chest drain systems function similarly by collecting and quantifying fluid drainage while allowing air to escape from the thorax if pressure rises above a certain level. Factors like tube size, positioning, suction level, and resolving the underlying issue determine when a chest drain can be removed.

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    © All Rights Reserved
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    ASSESSMENT OF CHEST DRAINS by Nick Mark MD ONE

    onepagericu.com Link to the


    most current
    @nickmmark version →
    Stepwise assessment of Chest Tube Function
    (For details for chest
    TUBE POSITIONING tube insertion see
    Underwater chest drain system combines DRAINAGE, a one-
    Look at the CXR: is the chest tube correctly Procedure way valve (WATER SEAL), and allows a precise amount of
    positioned to drain air/fluid? Are all six of the side Checklists)
    negative pressure to be applied (PRESSURE REGULATOR).
    holes within the chest cavity? Has it moved since a Modern systems provide the same functions.
    prior CXR?
    • If a chest tube is mal-positioned it may need to
    The old three bottle system illustrates the functionality: w all
    be removed/replaced. To ction
    su
    CHEST TUBE OUTPUT
    How much fluid output has there been in the last 24
    hours? Check the DRAINAGE area of the chest drain.
    • Generally, it is reasonable to remove a chest tube
    if the output is <200 ml/day. Note that there are usually
    • If a tube stops draining, fibrinolytics can be used 6 side holes on chest tubes.
    to clear obstructions. CHEST TUBE SIZING & POSITIONING
    Tubes sized by internal diameter (1 Fr =

    10-20 cm
    TIDALING (RESPIRATORY VARIATION) 0.3 mm). Recommended size varies by
    Tidaling indicates that the chest drain is within the indication:

    2cm
    pleura and transducing the pleural pressures. Look • 14-22 Fr stable pneumothorax
    for movement of the indicator ball in the chest • 24-28 Fr tension pneumothorax PRESSURE
    DRAINAGE WATER SEAL
    drain. Also look for cyclic movement of fluid in • 28-32 Fr hemothorax/empyema Allows air to escape from REGULATOR
    Collects and
    dependent loops of tubing. • Smaller pigtail drains placed by
    quantifies fluid the thorax if the pressure Determines how
    • You can temporarily disconnect suction (bend Seldinger technique may have
    draining from the rises above +2cmH2o. much suction is
    the suction tubing to occlude it) to make it equivalent outcomes. Bubbles indicate the
    thorax. applied.
    easier to evaluate tidaling. Ideal direction where tube is placed: presence of air leak.
    • For air ! anterior superiorly
    • For fluid ! posterior inferior A modern chest drain looks different but has the same functions:
    AIR LEAK
    Air leak is the presence of bubbles in the WATER
    SEAL chamber indicating that air is present within the WEANING A CHEST TUBE
    chest (or a leak is present in the drainage system). • Generally, chest tubes are initially
    Intermittent air leak occurring with the respiratory placed on suction. This facilitates Accordion indicates
    cycle (typically at end inspiration) indicates an injury air/fluid removal from the thorax. if suction is applied.
    to the lung or airways. Have the patient cough to see • Upon resolution of the pneumothorax When deflated (not
    if air leak occurs with higher pressures. or drainage of an effusion, suction can visible) no suction is
    Continuous air leak – throughout the respiratory be discontinued (this is called “being connected.
    cycle suggests either a large injury to lung or airways on water seal”)
    or a leak in the tubing. • Clamping a chest tube simulates
    removal. Though usually unnecessary, Indicator Ball moves up
    this is done prior to removal to and down transducing the
    SUCTION intra-thoracic pressure.
    ensure a pneumothorax does not

    v1.0 (2020-07-04)
    Is the drain connected to suction? How much recur. This can be useful if considering
    suction is applied? Be cautious about applying -20 removing a chest tube while on Column markings
    suction to large effusions as rapid drainage can positive pressure ventilation. quantify the degree of
    precipitate re-expansion pulmonary edema.
    air leak: scored 1-7.

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