A chest tube is a flexible plastic tube inserted into the pleural space (between the lung and the chest wall) to remove abnormal collections of air, fluid, or blood. This procedure re-establishes the negative pressure required for the lung to fully expand and prevents complications like a collapsed lung. The tube connects to a closed chest drainage system, such as the Atrium unit, which manages output and prevents air from re-entering the chest cavity. A system exchange is necessary when the collection chamber reaches capacity, the unit is compromised (tipped over or cracked), or a medical order requires a change.
Essential Preparation for System Exchange
The process begins with assessing the patient’s respiratory status, including vital signs, oxygen saturation, and lung sounds, to establish a baseline. Administering ordered analgesia before the exchange helps ensure patient comfort and cooperation. The medical order for the system change must be verified, along with the prescribed level of suction, typically set at -20 cmH₂O.
Gathering all necessary equipment prevents delays and maintains a sterile field. Required supplies include the new sterile Atrium drainage unit, sterile water or saline for the water seal, antiseptic wipes, sterile gloves, and specialized chest tube clamps.
Before bringing the new unit to the bedside, the water seal must be primed by adding sterile fluid (usually 45 mL) to reach the 2 cm fill line, establishing the one-way valve. If the system uses dry suction, the internal regulator is pre-set, and the wall suction source must deliver a minimum vacuum pressure of -80 mmHg to activate the system’s bellows.
Step-by-Step Atrium Drainage Unit Change
The exchange starts with positioning the patient, typically in a semi-Fowler’s position, to facilitate drainage and access. Instruct the patient to take slow, shallow breaths or perform a Valsalva maneuver during disconnection, if appropriate, to minimize the risk of air entry. The exchange point is the connection site between the patient’s chest tube and the existing drainage unit’s tubing, often using an in-line connector.
Momentarily secure the system by turning off the wall suction source. Use specialized, non-crushing clamps to briefly occlude the patient’s chest tube tubing. This clamping stops air from rushing into the pleural space but must be done quickly to avoid a tension pneumothorax. Once clamped, quickly separate the connection between the old drainage unit and the patient’s tubing, maintaining aseptic technique.
Immediately connect the new, pre-primed Atrium unit to the patient’s tubing, ensuring a secure and airtight seal. Transfer the suction tubing to the new unit’s suction port and confirm the ordered suction level is set on the rotary dial. Turn on the wall suction to the required minimum vacuum pressure; the orange bellows in the suction monitor window should expand, confirming suction is active.
The most time-sensitive action is the immediate unclamping of the chest tube once the new system is fully operational and suction is engaged. The tube must never be left clamped for an extended period, as this can trap air or fluid and potentially lead to a pressure build-up. The brief clamping only facilitates the quick, sterile exchange, and the tube is unclamped as soon as the closed system is restored.
Post-Procedure Monitoring and Documentation
Immediately after the new Atrium unit is connected and unclamped, check the system for proper function, starting with the suction monitor. The orange bellows should be fully expanded past the indicator mark, confirming sufficient wall suction and applied negative pressure. Observe the water seal chamber for “tidaling,” the normal fluctuation of the water level with the patient’s breathing, which indicates the system is patent.
The water seal chamber monitors for air leaks; continuous bubbling indicates air escaping from the pleural space or a leak in the system. If a new, large air leak is observed, check connections for tightness. If the leak persists, the chest tube may be briefly clamped near the insertion site to locate the source. A post-procedure assessment, including a focused respiratory check and vital signs, ensures the patient tolerated the exchange.
Documentation is required to accurately track the patient’s clinical course and system function. The record must include the exact time and date of the system change and the total volume of drainage collected in the old unit before disposal. Note the color and characteristics of the drainage, the patient’s tolerance, and the verified settings of the new Atrium unit, including suction level and air leak status.