2, keep the chest closed drainage unobstructed:
(1) Observe the fluctuation of water column of drainage tube: The fluctuation of water column can not only observe the patency of closed thoracic drainage, but also reflect the degree of pulmonary dilatation. The fluctuation of water column is 3 ~ 250 px in normal and calm breathing, and it can be increased to 12-400 px in coughing and deep breathing. For patients with large residual cavity in chest cavity, the water column fluctuates greatly, some of them are as high as 500px, and even the liquid in the water-sealed bottle will suck people into the liquid storage bottle. With the expansion of the residual lung, the residual cavity becomes smaller, the negative pressure gradually decreases, and extubation can be considered if the water column fluctuates only 2 ~ 4 cm or slightly. The greater the fluctuation range of water column, the larger the residual cavity in the chest cavity, and the lung is not dilated properly. The gradual disappearance of water column fluctuation is one of the important signs of drainage tube removal; When the fluctuation of water column suddenly disappears, it is considered that the pipeline may be blocked or blocked.
(2) Squeeze the drainage tube regularly to ensure that the drainage tube is unobstructed: when the drainage fluid is bloody, squeeze the tube every 1-2 hours/time. During operation, hold the drainage tube with both hands at l0~ 15 cm, connect the hands back and forth, place the drainage tube between the finger pulp and thenar, and block the drainage tube with the other hand at a distance of 4-5 cm from the lower end of the forehand. The front hand quickly and forcefully squeezes the drainage tube at high frequency, and then both hands are released at the same time, so that blood clots or tissue blocks blocking the drainage tube are washed away by the impact of liquid or air in the drainage tube, and so on. Or stroke the tube with talcum powder: smear talcum powder on the surface of the chest tube, hold the upper chest tube with your right hand, and slide the chest tube with your left hand from top to bottom until your right hand releases the lower part of the chest tube. This method can increase the negative pressure of chest tube and discharge weak blood clots or coagulated cellulose.
3. Observing the gas discharge of the drainage tube, the air leakage can be divided into 3 degrees: when the patient coughs hard and holds his breath, the air bubbles in the drainage tube are discharged at I degree; Take a deep breath, when coughing, the bubbles will be discharged to the second degree; When breathing calmly, the bubbles are discharged to the third degree. I-II air leakage can heal itself after 2-5 days; The third degree can gradually become the second degree and the first degree, and it will heal itself in 5-7 days. If there is a large bronchial fistula or stump fistula, there will be signs of persistent third-degree air leakage, bleeding or infection, which requires separate treatment.
4. Nursing care of continuous negative pressure suction closed thoracic drainage: Generally, the negative pressure suction of closed thoracic drainage after thoracotomy should be 5-250px higher than the negative pressure at the end of inspiration. If the patient's lung elasticity is poor, the compression time is long, or the lung surface is covered with thin fibrous membrane, which leads to the difficulty of lung recruitment, or the patient's lung section continues to leak more after pneumothorax or pneumothorax, the negative pressure can be increased to 10-375px. Negative pressure suction should be set at a low negative pressure level from the beginning, and it should be fine-tuned slowly according to the patient's situation. During negative pressure suction, we should closely observe the changes of chest pressure and whether the patient has chest tightness, shortness of breath, cyanosis and increased bloody drainage. And judge whether the trachea is centered and whether the breathing sounds of both lungs are symmetrical. Generally, negative pressure suction should be used after 24 hours to prevent pleural effusion. In clinical work, negative pressure suction should not be adjusted or interrupted at will to prevent the expanded alveoli from collapsing again.
5. Prevention of infection: Everything must be sterile. When changing bottles and pulling out nozzles, wrap them with sterile gauze, keep the drainage tube, nozzle and drainage bottle clean, and wash them with sterile distilled water regularly. The water-sealed bottle should be located under the chest and cannot be inverted. The drainage system should be sealed and the joint should be fixed firmly to prevent chest infection.
6. Indication of extubation: 48-72 hours after closed thoracic drainage, observe that the drainage fluid is less than 50 ml and there is no gas overflow. When the chest X-ray shows that the lung is inflated or not leaking, and the patient has no dyspnea or shortness of breath, extubation can be considered. When extubating, instruct the patient to take a deep breath, quickly extubate at the end of inhalation, seal the wound with vaseline gauze, and bandage and fix it. Observe whether the patient has chest tightness, dyspnea, air leakage, exudation, bleeding and subcutaneous hematoma after extubation.