UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES           PROCEDURE:    122

MEDICAL CENTER                                          EFFECTIVE:       12/07

REVISION:

PROCEDURE                                               APPROVED:        12/07

 

PROCEDURE FOR FLUSHING CHEST TUBES FOR THE PATIENT EXPERIENCING AN EMPYEMA

 

PURPOSE:   To dilute thick, non-viscous fluid or pus and facilitate drainage from the pleural space.

 

**Key Point:  MD orders to flush chest tube MUST come from the physician/service that inserted chest tube.

 

**   Key Point:  Only chest tubes with 3-Way stop cocks present may be flushed.  Do not perform this procedure with Denver drains or large-bore chest tubes.

 

EQUIPMENT:

**Key Point:  Chest tubes are generally flushed with 10ml of NS q8 or q6 hours.  Orders may vary according to ordering physician.

 

NURSING ACTION:

 

PROCEDURE STEPS:

  1. Obtain written order to flush chest tube from MD/service that inserted chest tube.

  2. Check chest tube for presence of 3-Way stop cock, if this apparatus is not present STOP and call the MD/service that inserted tube.

  3. Fill 10ml syringe with 10ml of bacteriostatic NS.

  4. Wash hands and don clean exam gloves.

  5. Clean cap on stop cock with alcohol swab vigorously for 15 seconds.  Allow to dry.

  6. Connect a previously filled 10ml saline syringe taking care not to introduce air into the chest tube; then rotate long arm of stop cock towards the chest tube drainage system closing the flow towards the drainage system and opening the flow to the chest tube.  Flush with 10ml of NS.                                                                                                                                                 **Key Point:  Should not feel resistance.  If resistance is met, notify MD.

  7. After flushing the saline into the chest tube, DO NOT aspirate fluid (this could pull particulate matter into the small drain hole occluding it).  Turn stop cock long arm to close fluid flow to flush port, thus opening fluid drainage from the chest tube to the drainage system.

  8. Disconnect empty 10ml syringe and discard appropriately.

  9. Assess patient.  Assess closed drainage system and suction setting level (if ordered).

  10. Indicate time and amount of chest tube output on collection system by drawing a line at the level of drainage q shift or more frequently if ordered.

  11. Document each flush on the flowsheet in the input section.  document all chest tube drainage on the output section of the flowsheet.

 

 

 

 

 

 

 

 

                                                                                                           

REFERENCES:

 

RESOURCE PERSON(S):