CARING FOR CLIENTS WITH CHEST DRAINAGE SYSTEM

I. KNOWLEDGE
A. Purposes
1. Therapeutic:
a) To remove air and fluid from the thoracic cavity
b) To facilitate re-expansion of the lung.
2. Diagnostic:
a) To determine presence of intrathoracic bleeding
b) To measure the amount and rate of hemorrhage
B. Considerations
1. To prevent dislodgement and infection.
2. To know management of effective suction and drainage, pain relief.
3. To monitor the respiratory status.
4. To provide overall supportive care.
C. Materials
1. Prescribed drainage system
2. Water suction system and sterile water
3. Chest tube tray
4. Dressings sterile gloves
5. Rubber-tipped hemostats for each test tube (2)
6. 1 inch adhesive tape

II. SKILLS

1. Review the patient chart for the reason for the chest tube and location and insertion
date.
a. Knowing the reason for the chest tube and location informs the health care
provider on the type of expected drainage.

2. Bring equipment to bedside.

a. To ensure prompt and efficient care delivery

3. Perform hand hygiene. Identify patient using two identifiers and explain assessment
process to the patient. Create privacy to assess the patient and drainage system.
a. Hand hygiene reduces the transmission of microorganisms.
b. Proper identification provides patient safety measures for safe care.

4. Explain procedure and rationale to the patient.

a. The chest tube drainage process involves monitoring and managing the
drainage of air, fluid, or pus from the pleural space to ensure your lungs can
fully expand. The tube will be connected to a drainage system, which collects
the fluid or air. You'll need to keep the drainage system below chest level to
facilitate proper drainage. The healthcare team will regularly check the
drainage amount and the tube's position, and you'll need to report any changes
in your breathing or discomfort. Once the drainage has decreased to an
acceptable level and your lung function has improved, the tube will be
removed.

5. Complete respiratory assessment, ensure the patient has minimal pain, and measure
 vital signs. Place the patient in a semi-Fowler's position for easier breathing.
a. Patient should be in a semi-Fowler’s position, have minimal pain, have no
respiratory distress, and have no evidence of an air leak around the insertion
site, and no drainage from the insertion site or chest tube equipment.
b. Frequent assessment of the respiratory status is important if the patient’s
condition is stable, resolving, or worsening, and ensures that the chest tube is
functioning correctly.
c. Assessment should be every 15 minutes to 1 hour until patient is stable.
Increase monitoring if patient’s condition worsens.
d. Chest tubes are painful, as the parietal pleura are very sensitive. Ensure
patient has adequate pain relief, especially prior to repositioning, sitting, or
ambulation.

6. Move the patient’s gown to expose the chest tube insertion site. Keep the patient
covered as much as possible. Assess chest tube insertion site to ensure sterile
dressing is dry, intact, and occlusive.
a. The dressing should remain dry and intact; no drainage holes should be visible
in the chest tube.
b. Dressing is generally changed 24 hours post-insertion, then every 48 hours.
Chest tubes are generally sutured in place.

7. Ensure all connections are taped and secured according to agency policy. Gently
palpate and check insertion site for subcutaneous emphysema, a collection of air or
gas under the skin.
a. These measures are important to keep the system intact and prevent
accidental tube removal or disruption of the drainage system.
b. There should be no fluid leaking from around the site or sounds of air leaks
from insertion site.

8. Ensure tubing is not kinked or bent under the patient or in the bed rails, or compressed
by the bed. Collection chamber (drainage system) is below the level of the chest and
secured to prevent it from being accidentally knocked over.
a. Kinked or bent tubing could interfere with the drainage of the pleural fluid.
b. Dependent loops may collect fluid and impede drainage.
c. The long tube may be coiled and secured to a draw sheet with a safety pin
(allowing enough tubing so that the patient can move in bed comfortably) to
prevent dependent loops.

9. If the chest tube is ordered to be suctioned, note the fluid level in the suction chamber
and check it with the amount of ordered suction. Look for bubbling in the suction
chamber. Temporarily disconnect the suction to check the level of water in the
chamber. Add sterile water or saline, if necessary, to maintain the correct amount of
suction.

10. Observe the water-seal chamber for fluctuations of the water level with the patient’s
inspiration and expiration (tidaling). If suction is used, temporarily disconnect the
suction to observe for fluctuation. Assess for the presence of bubbling in the water-
seal chamber. Add water, if necessary, to maintain the level at the 2 cm mark.

11. Assess the amount and type of fluid drainage.

12. Measure drainage output at the end of each shift, mark the level on the container or
placing a small piece of tape to indicate the date and time.

13. Remove gloves.

14. Assist the patient to a comfortable position.

15. Wash hands.

CHANGING THE DRAINAGE SYSTEM

1. Obtain two padded Kelly clamps, a new drainage system, and a bottle of sterile water.
Add water to the water-seal chamber in the new system until it reaches the 2 cm mark.
Follow the manufacturer’s direction to add water to the suction system if suction is
ordered.
a. Chest tubes are clamped for specific reasons: To assess for an air leak, to
empty or change the collection bottle or empty the chamber, and to change the
disposable system.

2. Wear gloves.

3. Apply Kelly clamps 1.5 to 2.5 inches from the insertion site and 1 inch apart, going in
opposite directions.

4. Remove the suction from the current drainage system.

5. Unroll or use scissors to carefully cut away any foam tape on the connection of the
chest tube and drainage system. Using a slight twisting motion, remove the drainage
system. Do not pull on the chest tube.

6. Keeping the end of the chest tube sterile, insert the end of the new drainage system
into the chest tube.

7. Remove Kelly clamps. Reconnect suction, if ordered. Apply plastic bands or foam tape
on the connection site.

8. Assess the patient and the drainage system.

9. Remove gloves. Wash hands. Document.

Caring for a Jackson-Pratt Drain

A Jackson-Pratt (JP) drain is a medical device used to remove fluids that accumulate in areas
of the body post-surgery. Here are the purposes and considerations for using a Jackson-Pratt
drain:

Purposes:
1. To prevent the accumulation of fluids (such as blood, pus, or other secretions) in a
surgical site, which can lead to complications like infections or hematomas.
2. To allow healthcare providers to monitor the amount and type of drainage, which can
provide valuable information about the healing process and identify potential
complications early.
3. By removing excess fluids, JP drains help reduce pressure on tissues, promote better
healing, and reduce the risk of seromas or abscesses.
4. Draining fluids can reduce the risk of infection in the surgical area, as stagnant fluids can
be a breeding ground for bacteria.

Considerations:
1. Ensure proper placement and aseptic management to prevent infections.
2. Teach patients and caregivers how to care for the drain, empty it, and monitor for issues.
3. Regularly check and record drainage amount and characteristics; report sudden
changes.
4. Typically removed when drainage decreases, indicating healing.
5. Watch for infection, blockage, accidental removal, and tissue damage; address issues
promptly.
6. Secure the drain to minimize discomfort and mobility limitations; manage pain effectively.

Skills:
1. Check Doctor's order for wound care
a. Ensures the care provided aligns with the specific instructions and needs for the
patient's condition, promoting appropriate treatment and avoiding errors.
2. Gather the necessary supplies and bring to the bedside stand or overbed table.
a. Ensures that all materials are readily available, preventing interruptions during
the procedure and maintaining a sterile environment.
3. Wash hands
a. Reduces the risk of infection by eliminating potential pathogens from the hands
before the procedure.
4. Identify the client
a. Confirms the patient's identity to ensure the correct patient receives the
appropriate care, preventing medical errors.
5. Provide Privacy.
a. Maintains patient dignity and comfort by respecting their personal space and
privacy.
6. Explain the Procedure to client.
a. Informs the patient about what to expect, reducing anxiety and gaining their
cooperation during the procedure.
7. Place a waste receptacle near the working area
 a. Facilitates easy disposal of used materials and maintains a clean working
environment.
8. Assist the patient to a comfortable position that provides easy access to the drain and/or
wound area. Place a waterproof pad under the wound site.
a. Ensures patient comfort and accessibility to the wound, while the waterproof pad
protects the bedding from contamination.
9. Put on clean gloves; put on a mask or face shield if necessary
a. Protects both the healthcare provider and the patient from potential
contamination and infection.
10. Place the graduated collection container under the outlet of the drain. Without
contaminating the outlet valve, pull the cap off. The chamber will expand completely as it
draws in air. Empty the chamber's contents completely into the container. Use the gauze
pad to clean the outlet. Fully compress the chamber with one hand and replace the cap
with your other hand.
a. Ensures the drain is emptied properly and maintains sterility, reducing the risk of
infection. Compressing the chamber re-establishes suction for continued
drainage.
11. Check the patency of the equipment. Make sure the tubing is free from twists and kinks.
a. Ensures the drainage system functions correctly, preventing blockages that could
lead to complications.
12. Secure the Jackson-Pratt drain to the patient's gown below the wound with a safety pin,
making sure that there is no tension on the tubing.
a. Prevents accidental dislodgement and ensures the drain remains in the correct
position without pulling on the wound site.
13. Carefully measure and record the character, color, and amount of the drainage. Discard
the drainage according to facility policy. Remove gloves.
a. Provides important information for monitoring the patient’s healing process and
detecting potential complications, while safe disposal of drainage prevents
contamination.
14. Put on clean gloves. If the drain site has a dressing, redress the site Include cleaning of
the sutures with the gauze pad moistened with normal saline. Dry sutures with gauze
before applying the new dressing
a. Put on clean gloves and redress the drain site with sterile technique to maintain
wound cleanliness and prevent infection.
15. If the drain site is open to the air, observe the sutures that secure the drain to the skin.
Look for signs of pulling, tearing, swelling, or infection of the surrounding skin.
a. Inspect and clean sutures to prevent complications such as infection or skin
irritation, ensuring optimal healing and comfort for the patient.
16. Gently clean the sutures with the gauze pad moistened with normal saline. Dry with a
new gauze pad. Apply skin protectant to the surrounding skin if needed.
a. Ensure patient comfort and safety by removing equipment, adjusting bed
position, and maintaining a clear environment.
17. Remove and discard gloves. Remove all remaining equipment; place the patient in a
comfortable position, with side rails up and the bed in the lowest position.
a. Maintain hand hygiene to prevent the spread of infection between patients and
during wound care.
18. Remove gloves. Wash hands.
a.
19. Check drain status at least every four hours.
a. Regularly monitor drain status to promptly identify changes in drainage and
prevent complications.
Caring for a Penrose Drain

A Penrose drain is a type of surgical drain used to remove fluids from a wound or surgical site. It
consists of a soft, flat, and flexible tube made of latex or silicone rubber.

I. KNOWLEDGE

Purposes of the Procedure

● To drain fluids from a wound or surgical site.
● To prevent the accumulation of fluids that could lead to infection or other complications.
● To promote healing by reducing pressure and fluid buildup.

Considerations in Caring for Penrose Drain

 ● Monitoring for signs of infection such as increased drainage, redness, or swelling.
● Preventing the drain from becoming dislodged to maintain its effectiveness.
● Regular assessment of drainage characteristics to monitor patient recovery.

Materials Used
1. Sterile gloves
2. Sterile saline solution
3. Sterile gauze sponges
4. Cotton-tipped applicators
5. Pre split drain sponge
6. Abdominal pads
7. Tape, Montgomery straps, or roller gauze
8. Waste receptacle
9. Waterproof pad

II. SKILLS

1. Check Doctor's Order for Wound Care:

a. Ensures adherence to prescribed treatment, promoting patient safety and
recovery.
2. Gather the Necessary Supplies and Bring to the Bedside Stand or Overbed Table
a. Facilitates efficient and organized care delivery, reducing procedural
interruptions.
3. Wash Hands
a. Prevents the transfer of microorganisms, reducing the risk of infection.
4. Identify the Client and Explain the Procedure
a. Verifies patient identity and promotes informed consent and cooperation.
5. Provide Privacy
a. Respects patient dignity and promotes comfort during care procedures.
6. Place a Waste Receptacle Near the Working Area:
a. Ensures proper disposal of contaminated materials, maintaining a clean
environment.
7. Assist the Patient to a Comfortable Position That Provides Easy Access to the Drain
and/or Wound Area. Place a Waterproof Pad Under the Wound Site:
a. Enhances patient comfort and facilitates effective wound care management.
8. Put on Clean Gloves; Put on a Mask or Face Shield if Necessary
a. Prevents contamination and protects both the patient and healthcare provider.
9. Check the Position of the Drain or Drains Before Removing the Dressing. Carefully and
Gently Remove the Soiled Dressings. If Any Part of the Dressing Sticks to the
Underlying Skin, Use Small Amounts of Sterile Saline to Help Loosen and Remove:
a. Minimizes trauma to the wound and surrounding skin, promoting healing.
10. Note the Presence, Amount, Type, Color, and Odor of Any Drainage on the Dressings
a. Provides critical information for assessing wound status and detecting
complications.
11. Place Soiled Dressings in the Appropriate Waste Receptacle
a. Ensures proper disposal of contaminated materials, preventing cross-
contamination.
12. Inspect the Drain Site for Appearance and Drainage. Assess if Any Pain is Present
a. Monitors wound healing progress and detects signs of complications early.
13. Using Sterile Technique, Prepare a Sterile Work Area and Open the Needed Supplies:
a. Maintains asepsis, reducing the risk of infection during wound care.
14. If Open the Sterile Cleaning Solution. Pour the Cleansing Solution Into the Basin. Add
the Gauze Sponges
a. Ensures proper preparation of materials for wound cleansing, maintaining
sterility.
15. Put on Sterile Gloves
a. Maintains a sterile field during wound care procedures, minimizing infection risk.
16. Cleanse the Drain Site With the Cleaning Solution. Use the Forceps and the Moistened
Gauze or Cotton-Tipped Applicators. Start at the Drain Insertion Site, Moving in a
Circular Motion Toward the Periphery. Use Each Gauze Sponge or Applicator Only
Once. Discard and Use New Gauze if Additional Cleansing is Needed
a. Removes debris and bacteria from the wound, promoting healing and preventing
infection.
17. Dry the Skin With a New Gauze Pad in the Same Manner. Place Presplit Drain Sponge
Under the Drain. Closely Observe the Safety Pin in the Drain. If the Pin or Drain is
Crusted, Replace the Pin With a New Sterile Pin. Take Care Not to Dislodge the Drain:
a. Maintains the integrity of the drainage system and prevents complications such
as accidental dislodgement.
18. Apply Gauze Pads Over the Drain. Apply Abdominal Pads Over the Gauze
a. Provides additional protection and absorption for wound drainage, promoting
cleanliness and comfort.
19. Remove and Discard Gloves. Apply Tape, Montgomery Straps, or Roller Gauze to
Secure the Dressings
a. Secures dressings in place, preventing displacement and maintaining wound
care integrity.
20. After Securing the Dressing, Label Dressing With Date and Time
a. Ensures accurate documentation and monitoring of wound care status over time.
21. Remove All Remaining Equipment; Place the Patient in a Comfortable Position:
a. Ensures patient comfort and safety following the procedure.
22. Remove Gloves. Wash Hands
a. Maintains hand hygiene, reducing the risk of infection transmission.
23. Check All Wound Dressings Every Shift:
a. Monitors wound healing progress and detects any changes or complications
promptly.