Chest Tubes

Nurses General Nursing

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Hey there! I am a RN fresh out of Nursing School and have been working in the ICU setting for over 2 months now and I have a general question about CT's and UWSD. I am familiar with the UWSD and the proper usage of them as well, but I have a question. Whenever the fluid from the CT begins to "back up" into the tubing, I have a hard time in draining the fluid into the Glass Bottle. The only way that I am able to drain the fluid coming from the CT is to unscrew the top and lift up on the tubing enough to where the fluid begins to drain into the bottle, but not to the point where all of the fluid drains out and allow air to reach inside the CT. Is this an unorthodox practice? If so, what are some other ways that I can drain the fluid out of the CT so that it doesn't back up?

Specializes in ICU/PCU/Infusion.

I'm sorry, but I have no idea what you're talking about. In the hospital where I work, we don't use glass bottles for chest tubes, we use atrium chest tube drainage systems, either to Low Wall Suction or to gravity. I'm also not sure about fluid "backing up".. that sounds like asking about urine in a foley catheter tubing before it gets to the drainage bag.

I'm also clueless about what a UWSD is. Can you explain that please? Maybe if we had more of an inkling of what it is you are referring to, we could offer better assistance.

I can tell you this though. For the chest tube systems we use, we would NEVER unhook anything and allow it to drain in or out. When the tubing or the atrium has to be changed because it either has a leak or it has been turned over accidentally, we always use great caution to not allow air into the tubing. With air, comes bacteria, and of course allowing microorganisms into a tubing that leads directly into the chest wall and pleura would/could be disastrous for the patient. Set them up for a horrid infection.

Maybe that's not at all what you are talking about.

If you are talking about a thoracentesis into glass bottles, those are only done by MD's. The nurses don't have anything to do with those, except to gather the supplies and assist as requested.

Specializes in Medsurg/ICU, Mental Health, Home Health.

i'm also clueless about what a uwsd is.

i'm just going to guess...under water seal device? i could be very wrong.

but i'm also going to shut up because i only have experience with the atrium device myself! hopefuly someone can help.

jess

allnurses Guide

XB9S, BSN, MSN, EdD, RN, APN

1 Article; 3,017 Posts

Specializes in Advanced Practice, surgery.

Underwater seal drain is my guess too.

Have a look at this protocol from the Midlands Hospital. It gives good evidence based guidence to the management of these drains

http://www.mhb.ie/mhb/OurServices/PoliciesProceduresGuidelines/Appendix1/EpisodicCare/IntensiveCareUnit/d7987.PDF

mdedmon85

5 Posts

Well, we use both the Atrium and the Glass Bottles ( and yes, I was referring to UWSD as the Under Water Seal Drainage), just depends on who the doc is. But when I work with the Glass bottles, the higher the level of fluid gets inside the bottle, it takes a longer time for the fluid to drain from the CT, causing it to build up in the straw that is under the water seal and the chest tubing.

So to drain the fluid that builds up in there, I unscrew the lid of the glass bottle and lift the straw slightly up from the water seal until it starts to drain the fluid again but quickly put it back under the water seal when it gets close to draining the fluid that builds up in the CT so that I don't get any air into the CT.

My question is that is this a bad practice to be doing, and if so, what are some other ways I can use to help to drain the fluid from the CT into the glass bottle?

Sorry if this confusing to you guys!

AnthonyD

228 Posts

Specializes in Critical Care, Med-Surg.

If it's a 1000ml bottle, it will probably have to be changed when the fluid gets up over 500ml's otherwise there isn't enough vacuum to drain the tube.

Hope that helps.

Best bet is to ask the other nurses what they generally do.

SICU Queen

543 Posts

Specializes in SICU.

Jeeeeeeeeeeezus! Glass bottles? I can honestly say I've never had to use that type of system in the almost 15 years I've been nursing. If it's like what I remember seeing in pictures during nursing school, it seems rather archiac.

Do glass bottles have some advantage over systems like Atrium?

Hey there! I am a RN fresh out of Nursing School and have been working in the ICU setting for over 2 months now and I have a general question about CT's and UWSD. I am familiar with the UWSD and the proper usage of them as well, but I have a question. Whenever the fluid from the CT begins to "back up" into the tubing, I have a hard time in draining the fluid into the Glass Bottle. The only way that I am able to drain the fluid coming from the CT is to unscrew the top and lift up on the tubing enough to where the fluid begins to drain into the bottle, but not to the point where all of the fluid drains out and allow air to reach inside the CT. Is this an unorthodox practice? If so, what are some other ways that I can drain the fluid out of the CT so that it doesn't back up?

I wish I could help you. I didn't even know glass bottles were in use this century. What city do you work in??? Since I've been a nurse I have only seen Pleurovacs, Atriums and a few other plastic contained chest tube drainage systems

Specializes in Medsurg/ICU, Mental Health, Home Health.

do glass bottles have some advantage over systems like atrium?

although i've never used the glass bottles, i know that some of the pulmonologists in my last health care system refuse to use anything but on their patients! i don't know if they know of an actual advantage, or don't want to change...

jess

sfsn

65 Posts

I don't have experience with using glass bottles for chest tubes either...I'm assuming you have 2 bottles in the set up, one with the water seal and then one for the fluid collection?

If that's the case, do you mean you are lifting the straw out of the water that you are using for the water seal, or are you lifting it out of the fluid that you are draining from the patient's chest?

clayah

25 Posts

Can anyone out there help me?

I have been asked to do an in service on Chest Tubes for Pleurovac system and have been searching for a good Competency List to check the nurses off with this.

I am creating one myself because I have been unable to acess any information from "Pleurovac" company.

There are great competencies for "Atrium" but we don't use "Atrium."

Does anyone have any suggestions? These will be greatly appreciated.

Also this has been a great thread - woow 2 months out of Nursing school and working in the ICU!

Thanks for any help.

clayah

25 Posts

Great postings!

Can anyone help me - I need to find a competency checklist for Pleurovac chest tubes? It's for an in service.

I have found Atrium competencies but unable to find ones for Pleurovac.

Thanks.

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