Guidelines to the Nurse’s

role in the management of

the patient with WSCD

Budhi adhiwidjaja
 An intrapleural drainage tube is
used after most intrathoracic
procedures. One or more chest
catheters are held in the pleural
space by suture to the chest wall
and are attached to a drainage
system.
 The purpose are:
 To remove solids, liquids, and gas from
the pleural space or thoracic cavity and
the mediastinal space.
 To bring about reexpansion of the lung
and restore normal cardiorespiratory
function after surgery, trauma, or medical
conditions.
 Nursing Action.
 Attach the drainage tube from the pleural space
to the tubing that leads to a long tube with end
submeged in sterile normal saline.
 Tape the places where the tubing is connected,
if needed. Some connectors hold without taping.
a) The tube should be approximately 2,5 cm
below the water level.
b) The short tube is left open to the
atmosphere.
 N A.
 Mark the original fluid level with tape on
the outside of the drainage bottle. Mark
hourly/ daily increments at the drainage
level.
 Ensure that the tubing is not looping or
interfering with the movement of the
patient.
 N A.
 Encourage the patient to assume a
position of comfort. Encourage good body
alignment. When the patient is in the
lateral position, place a rollerd towel under
the tubing to protect it from the weight of
the patient’s body. Encourage the patient
to change position frequently.
 N A.
 Put the arm and shoulder of the affected
side through range of motion exercises
several times daily. Some pain medication
may be necesssary.
 Milk” the tubing in the direction of the
drainage bottle hourly.
 Make sure there is fluctuation of the fluid
level in the long glass tube
 NA
 Fluctuation of fluid in the tubing will stop
when: The lung has reexpand.
The tubing is obstructed by blood
clots or fibrin.
A dependent loop develops.
Suction motor or wall suction is not
working properly.
 N A.
 Watch for leaks of air in the drainage
system as indicated by constant bubbling
in the water seal bottle:
a) Report excessive bubbling in the
water-seal chamber immediately.
b) Milking” of the chest tubes in patients
with air leaks should only be done if
request by the surgeon
 NA
 Observe and repot immediately signs of
rapid, shallow breathing; cyanosis;
pressure in the chest; subcutaneous
emphysema; or symptoms f hemorrhage.
 Encourage the patient to breathe deeply
and cough at frequent intervals. If there
are sings of incisional pain, adequate pain
medication is indicated.
 NA
 Stabilize the drainage bottle on the floor or in a
special holder’
 If the patient has to be transported to another
area, place the drainage bottle below the chest
level (as close to the floor as possible) if he is
lying on a stretcher. If the tube becomes
disconnected, cut off the contaminated tips OF
THE CHEST TUBE AND TUBING, INSERT A
STERILE CONNECTOR IN THE CHEST TUBE AND
TUBING, AND REATTACH TO THE DRAINAGE
SYSTEM
 N A.
 When assisting surgeon in removing the tube:
a) instruct the patient to perform the valsalva
maneuver’
b) The tube is clamped and quickly removed.
c) Simultaneously a small bandage is applied
and made airtight with ointment gauze covered
by 4X4 gauze and thoroughly cover and sealed
with adhesive tape.
 Evaluation
 Improves breathing.
 Is relieved of pain and discomfort.
 Improves musculoskeletal functioning of
affected arm and shoulder.
 Copes of anxiety.