Policy Manual sample

MDT Home Health Care Agency, Inc. It is imperative that the nurse evaluate the patient for a life threatening situation, such as a tension pneumothorax. If medically necessary per the physician’s orders, set up the chest drainage unit and gather the thoracotomy tray while monitoring the patient's vital signs. Changing the Chest Drainage Unit If the drainage collection chamber is full, set up a new chest drainage unit: • Instruct the patient to exhale and hold his or her breath (perform the valsalva maneuver). • Clamp the chest tube with a padded Kelly clamp about one to two inches from the patient. • Place a second clamp distally. Aseptically, disconnect tubing from old chest drainage unit and connect to the new chest drainage unit. • When completed, remove clamps within one minute and have your patient breath normally. • At the end of changing the chest drainage unit, secure all connections with tape. Patient Education When a patient has a chest tube, the patient will require specific instructions to help re-expand the lung: 1. The nurse should teach turn cough deep breathing and incentive spirometry. 2. If the patient splints with coughing or has decreased breath sounds, more analgesic is often needed so that the patient can be pain free while taking a deep breath. It is important to evaluate the patient's need for pain medications to prevent hypoventilation, compliance, atelectasis, and pneumonia. The nurse should monitor the patient’s subjective pain level with the facility approved pain scales and vital signs. The patient should receive prescribed pain medications as ordered. If a patient splints while coughing and is not taking deep breaths due to high pain levels, the lung will not be able to re-expand. 3. Getting a patient out of bed or encouraging ambulation with the physician's order also helps. With movement, pain medications are often required in order for a patient to tolerate these activities. Prior To Discontinuation of the Chest Tube (not at home) Certain important criteria must be met prior to removing a chest tube and the underlying condition that required the use of the chest tube should be resolved. • If the chest tube was used to drain fluid, the lung should be fully expanded and the daily fluid output should be less than 100 to 200 ml/day. • If the chest tube was placed to respond to a pneumothorax, the lung should be fully expanded and an air leak should not exist during suction or coughing. Documentation • Describe of drainage (serous, sangineous, serosangeounous). • Date and time of the drainage amount on the chest drainage unit. • Total amount of drainage on intake/output flowsheet. • Type and amount of suction. • Date/time of dressing change. Follow doctor’s order on frequency. Note any redness around the insertion site, any purulent drainage, any odor, or crepitus. • Air leak presence or absence. • Respiratory status. • Patient or family education. An Alternative to Chest Drainage Units The Heimlich chest drainage valve is an alternative method of draining the chest cavity, without using a chest drainage unit. Also known as a flutter valve, the Heimlich valve connects to chest tubing and allows fluid and air to pass in one direction only. The valve, which functions in any position, need never be clamped, and regulated suction can be attached to it if necessary. The valve drains into a plastic bag that can be held at any level, allowing the patient undergoing chest drainage to be ambulatory simply by carrying the bag. Home Health Agency Nursing Care & Procedures K-217