Accidental tube disconnection

Accidental tube disconnection

Pneumothorax

· do not clamp tubing (risk of causing tension Pneumothorax)

· place connection in a sterile paper towel

· prepare and connect a new bottle and tubing immediately

· alert medical officer

· order a Chest X-ray, if patient self ventilating

· document the event in the nursing notes

Haemopneumothorax and pleural effusion

· do not clamp tubing

· place connection into sterile jug or container to allow for free uninterrupted drainage of air and fluid

· place a telfa dressing over the tube insertion site

· tape 3 sides ONLY of dressing with adhesive tape

· notify medical officer immediately

· prepare for reinsertion of intercostal tube and reconnection of UWSD immediately

· order a chest X-ray if patient is self-ventilating

· document the event in the nursing notes

Changing underwater seal drainage bottle and tubing

Change if excessive drainage (700ml) post cardiac surgery or daily for long term thoracic patients.

Equipment Sterile drainage bottle, Blue Chlorhexidine 1:200, chest drainage tubing pack, sterile measure jug, sterile disposable sheets x 2, alcohol wipes, Howard Kelly forceps x 2,adhesive tape, rubber band and safety pin.

Procedure

· position the new bottle and tuck wrapped end of tubing in sterile sheet under mattress or secure spot

· remove the adhesive tape from along the connection nearest the drainage catheter

· wash hands thoroughly

· clamp the drainage catheter close to the patient with two Howard Kelly forceps

· position a sterile sheet under the connection and the catheter. Using an alcohol wipe, disinfect the catheter and connection, leaving the alcohol wipe on the catheter.

· using another sterile sheet disconnect the connection from the catheter, wrap this tubing in the sterile sheet and place under mattress

· remove the wrapper from the new drainage tubing and connect the tubing to the catheter. Ensure that the tubing is pushed firmly onto the catheter and discard the alcohol wipe

· remove the Howard Kelly forceps

· tape the connection as illustrated

· support the tubing by securing it to the bottom sheet or clothing with the rubber band and safety pin

Dressing of the insertion site

Equipment Dressing pack, alcohol wipes, Povidone iodine ointment, sodium chloride 0.9% sachet, Primacore dressing (18cm)

Procedure

NB Remove tape with care to prevent dislodgement of the catheter.

· apply povidone iodine around insertion site

· apply tube dressings, in opposing directions around the catheter

· secure dressings and catheter with adhesive tape as shown in diagram

Guidelines UWSD suction

The medical officer must indicate in the treatment record chart whether low pressure suction is required. There are absolute contraindications to low pressure suction (lung volume reduction surgery, pneumenectomy) and therefore the orders must be clearly documented.