Every time when assessing the patient’s condition during aspiration, it should be checked whether the drainage is functioning. If the drainage is carried out without a pump, you should monitor the level of fluid in the chamber, which serves as a hydraulic valve. With the passage of drainage and its location in the pleural cavity, the fluid level in this chamber should rise during inhalation, when the pressure becomes more negative, to decrease — as you exhale. If during spontaneous breathing such fluctuations in the fluid level is not observed, then the patient should be asked to take a maximum breath. If in this case there is no oscillation of the fluid, it means that the drainage is not functioning.
If aspiration is performed using a pump, then it is much more difficult to check the functioning of the drainage. The entry of large air bubbles into the suction control chamber causes fluctuations in the level of the fluid in the chamber, which serves as a hydraulic shutter, depending on the number and size of incoming air bubbles. These fluctuations in fluid level should not be considered evidence of the functioning of drainage. When performing drainage with a pump, the discharge pressure in the pump must be constant to ensure constant pressure in the pleural cavity. In order to follow the pressure change during the breathing cycle, it is necessary to temporarily turn off the pump. When the pump is disconnected due to the fact that the volume of air and fluid between the hydraulic shutter and the pleural cavity does not change, a rise in the level of fluid in the chamber serving as a hydraulic shutter should be observed in order to balance the previously created negative pressure. This rise in fluid is observed both in the case of patency and obstruction of drainage, but subsequent fluctuations in fluid associated with the respiratory cycle are observed only in the case of drainage functioning.
If the drainage is not functioning, then its patency must be restored. In many cases, the permeability of drainage in the extrathoracic region can be restored by a series of pressures on the drainage tube. To do this, hold the tube close to the chest with the index and thumb fingers of one hand and push the other hand, pushing it forward, in a direction of the draining system. Then move the first hand, placing it next to the second, and repeat the procedure until the drainage is cleared along its entire length. Sometimes, a special drainage roller is used for these purposes, Â as a result of such a procedure, drainage patency can be restored.
Drainage with impaired permeability, which no longer remove fluid, should be removed from the pleural cavity, as they serve as a conduit for infection. It should be borne in mind that it is impossible to restore the permeability of drainage by introducing air or fluid through it into the pleural cavity, since the drainage is often clogged with clots that can contain bacteria, and if such clots enter the pleural cavity, they can be a source of infection. In some cases, the drainage functions intermittently, as a result of which, although aspiration of the discharge takes place, the drainage tube cannot be considered passable. In such cases, it should be replaced.
The number and nature of the pleural discharge
The number and nature of the pleural discharge should be recorded every 24 hours. The volume of fluid withdrawn is easiest to determine, noting its level in the discharge chamber every day. Such registration is necessary, since in many cases, the decision on further treatment often depends on the amount of fluid that is withdrawn from the pleural cavity. The nature of the pleural fluid is best described by indicating the amount of solid particles in it. This is easy to do by noting the level of sediment in the discharge chamber every day. Getting daily information about the volume of discharge and the amount of sediment, you can determine what percentage is the sediment from the total amount of output fluid.