POLICY Physician s order will specify the level of underwater seal, typically -10 to 20 centimetres (cm) and will identify if suction is to be applied. The dry suction system provides many advantages: higher suction pressure levels can be achieved, set-up is easy, no continuous bubbling provides for quiet operation, no fluid to evaporate decreasing the amount of suction and air leak detection is clear. Note: Dry suction chest drain system (Oasis) is MRI compatible. PROCEDURE Gather Equipment 1. Chest drainage unit (Atrium Oasis) 2. Mask 3. Pink waterproof tape 4. Sterile connection tubing 5. Sterile drape 6. Suction regulator 7. Tubing adaptor/ sterile scissors A. Suction control regulator B. Water Seal Chamber C. Air Leak Monitor D. Collection Chamber E. Suction Monitor Bellows F. Positive Pressure Release Valve G. Manual High negativity vent H. In-Line Connector I. Patient Tube J. Suction port Page 1 of 5
Procedure 1. Attach suction regulator to vacuum outlet on wall if suction is required. 2. Wash hands and mask. 3. Open chest drain package. Notes Any suction regulator can be used (thoracic/cm H 2 O or standard/ mmhg). (cm/water, millimetres mercury) Suction bellows visible in the bellows window indicates adequate wall suction. May need to increase wall suction if more than one chest drain is connected to a single suction regulator. 4. Open floor stand for setup. Floor stand avoids accidental knock over. For suction: 5. Adjust rotary dial to set SUCTION REGULATOR to ordered suction pressure (- 10 to -20 cm H 2 0 suction). suction regulator dial The suction regulator is pre-set to -20 cm H 2 0 directly out of the package. suction port 6. Remove plastic ampoule of pre-filled sterile water from back of unit. Fit tip into SUCTION PORT and squeeze contents into WATER SEAL COLUMN until reaches 2 cm fill line. Water turns blue after filled. This allows for air bubbles to be seen easier. Maintain water seal at the 2 cm level for proper operation and check regularly when used for extended periods. Additional water added by a 20 gauge or smaller needle and syringe via the grommet located on the back. Page 2 of 5
7. Remove connecting tubing from packaging on back off unit. Cut off packaged adaptor from the patient end of connecting tubing Replace with smaller diameter adaptor. Wrap end in sterile towel. connecting tubing Replacement adaptor: Remove adaptor Remove adaptor 8. Attach (blue tipped) connection tubing to suction port and then to wall suction regulator. Set suction Leave suction OFF. For gravity drainage: Do not attach suction tubing to suction port. Suction tubing to suction port 9. Turn suction source on when chest tube attached to chest drain unit. Set suction source so the bellows are visible are visible in the bellows monitor window E.g. set the suction regulator dial (on the device) to - 10 cm H 2 O dial, the bellows may be short of the triangle mark. The triangle mark is there as a target when the regulator is (automatically) set to -20 cm H 2 O. Setting the bellows at or just short of the triangle mark will provide ample suction power when the device is set at -10 cm H 2 O. Page 3 of 5
10. Check (orange) suction bellows: Needs to be visible in the window, increase wall suction regulator if needed. For a 10 cm H2O setting does not need to does for -20 or higher regulator setting. bellows To attach second chest tube to the same chest drain unit, check bellows is still seen in the window and increase wall suction above -80 mmhg if required. May need to have each chest drain with its own drainage system and/or with its own separate suction regulator. 11. Check air leak monitor in WATER SEAL CHAMBER. Continuous or intermittent bubbling in the bottom of the air leak monitor confirms an air leak. Air bubbles will move from right to left. The more air leak, the more to the left the bubbling will reach. Persistent continuous bubbling may mean a leak in the chest tube or drainage system. Briefly clamp the patient s chest tube, if bubbling continues, there is a leak in the system. To confirm catheter patency, temporarily turn off suction and check that oscillation of patient pressure float ball in water seal chamber coincides with patient s respirations. Float ball will rise with increased negative pressure upon inspiration and lower upon expiration. The effect will be opposite if patient is ventilated. 12. Check positive pressure release valve is not obstructed. 13. Secure connections between chest tube and connecting tube and adaptors with pink tape. Tape placement should allow unobstructed view of the connection site. 14. Review and initiate SCP: Care of the Infant with Chest Tube. 15. Collect sample of the drainage: Directly from the patient tube by forming a temporary dependent loop and inserting a needle at an oblique angle, or From the front face grommet located in the collection chamber using a 20 gauge or smaller syringe needle can be inserted. Do not puncture patient tubing with an 18 gauge or larger needle. Wipe self-seal diaphragm with chlorhexidine/alcohol swab and allow to dry. Using 18 gauge needle or smaller, aspirate 1-2 ml for analysis as ordered. Complete Miscellaneous Requisition. Page 4 of 5
Chest Drainage System Knocked Over: Should this occur, place upright and check water seal chamber (B) and drainage collection chamber (D). Remove excess fluid or top up (using sterile water) the water seal chamber to maintain at the 2 cm level using the grommet at back of the drainage system. If drainage fluid has moved out of the appropriate column(s) in chamber (D), gently tip drainage system sideways to enable fluid to move back. Manual High Negativity Vent: To lower the height of the water column in chamber (B) when a loss of water seal is occurring, temporarily depress the vent on top of the drainage system until the float valve releases and the water column in the water seal chamber (B) lowers to the desired level. Only to be used when drainage system is connected to suction. DOCUMENTATION Caring for Infant with Chest Tube Standard Care Plan Miscellaneous Requisition. REFERENCES Atrium www.atriummed.com Some chest drains may not connect to the dry suction unit without additional adaptation to the connector fit. Page 5 of 5