Policy Manual sample

MDT Home Health Care Agency, Inc. source. The stopcock must be on for initial system setup and should not be turned off during patient use. Step 6: Placement of unit. For optimum drainage results, always place the chest drain below the patient’s chest in an upright position. To avoid accidental knock-over, it is prudent to swing the floor stand open for secure placement on floor or to hang the system bedside if hangers are provided. Setting Up a Dry Suction Water Seal System In recent years, there has been an advancement in technology and there is now dry suction water seal chest drainage system. The steps are minimally different when setting one up: 1. Fill the water seal chamber to the specified level from the manufacturer (which is usually the -2 cm) 2. The physician will order the amount of suction (e.g., Chest tube to -20 cm H2O). Using the dial, place the arrow at the correct amount of suction and document. 3. The tubing on the suction control chamber is then attached to the wall suction. The nurse should start with a lower suction level and gradually increase suction until a gentle bubbling in the suction control chamber is noticed. To operate the suction container at -20 cm H20, wall suction must have at least -80 mm Hg of vacuum. Occlusive Dressing The type of dressing applied after chest tube insertion often differs with each facility so it is important to be familiar with and follow your facility policy. All chest tube dressings should be an occlusive, air tight dressing to prevent air leaks. Steps to applying a chest tube dressing: • Always use sterile technique when applying a chest tube dressing. • Slide a pre-slit 4X4 around the chest tube on the skin around the tube. • Following the slit drainage pad, place an un-slit 4X4 on top. • With a 3-4 inch tape, secure the dressing with an airtight seal. • Frequency of dressing changes should be done per hospital policy. Note any redness around the insertion site, purulent drainage, odor, or crepitus. In order to keep the dressing occlusive and to avoid an air leak, tape all the connections from the insertion site of the patient to the chest drainage unit. CARE OF THE PATIENT AFTER CHEST TUBE INSERTION A. Patient should be able to breathe easier if previously short of breath. The patient may experience coughing after insertion. 1) Assess lung sounds after chest tube insertion 2) If patient develops symptoms of shortness of breath, increased pulse and respiration, chest pains, or any other signs of respiratory distress. Check tube connections, status of the system, lung sounds, and notify the physician at once. 3) Check for fluctuation of drainage in tubes or drainage bottle to ascertain patency. NOTE: When air leak from lung is finally sealed off, no bubbling will be present. B. Monitor output from chest tube every visit and PRN, as ordered. Notify the physician if the patient has a drainage rate that is increasing progressively (or „d 200 ml/hr). C. Educate caregiver Turn, cough, and deep breathe the patient at least every two (2) hours (or per MD order) while awake. Splint the chest when coughing. Place patient in semi-Fowler’s position to facilitate the air to rise and make sure tubes are not kinked or pulled on. D. Note the pressure of suction every time the patient is assessed. E. The dressing should be occlusive. If dressing becomes soiled, check with the physician before changing. Note hematomas and amount and consistency of the drainage, and chart specifically. F. When assisting the patient to a chair or stretcher, keep chest tube system lower than patient's chest at all times. If the patient needs to be transported via stretcher, make sure the chest tube system stays below the level of the chest. Home Health Agency Nursing Care & Procedures K-213