Small bottle with big truth

This is the 4767th article of Da Yi Xiao Hu

Children with congenital heart disease (hereinafter referred to as CHD) usually need to have a chest tube and chest bottle placed after surgery to drain the accumulated air and fluid in the pleural cavity and to detect active bleeding in a timely manner. It usually takes about a week, during which time our children often ask the nurses the following questions:

Q1Will it be painful for a child to have a chest tube left in his body?

The chest tube is usually placed in the child's body at the end of the operation. At that time, the child is under anesthesia and will not feel any pain. When the child wakes up and sees the tube in his body, he will not feel much pain, because painkillers will be used at this time. If the child feels abnormal pain where the chest tube is connected to the body, he must tell the nurse, who will work with the doctor to make the chest tube behave well without causing pain.

Q2Why should the chest drainage bottle be placed under the bed?

Because the human pleural cavity is in a negative pressure state, the gas and fluid accumulated in the pleural cavity can only be discharged through the airtightness and height difference of the chest drainage bottle. When the liquid level in the bottle is 60 cm below the height of the chest drainage tube puncture plane, effective drainage can be maintained.

Q3Why do we need to put tape on children’s bodies and put small clips on their beds?

This is a double fixation method that can properly fix the chest tube and effectively prevent active children from pulling on the drainage tube and causing it to slip due to turning over or moving.

Q4What should I do if the liquid in the chest tube cannot flow out?

The nurse will periodically use a vascular clamp to squeeze the chest tube, squeeze the liquid in the tube into the chest tube bottle, and keep the chest tube unobstructed. Children should never hit or squeeze the tube hard.

Q5What color should the fluid in the chest tube be?

Under normal circumstances, the liquid in the chest tube should be meat-washing water or clear. If the child finds that the liquid suddenly turns bright red or has blood clots, it means there may be active bleeding, and the nurse must be called immediately to deal with it; if the liquid appears milky (milky white and turbid), it means there may be damage to the chest duct. At this time, the nurse must follow the instructions and not eat greasy food. If the diet is well managed, the color of the liquid will become clear.

Q6 What should I do if my child wants to get out of bed and move around?

If the child wants to get out of bed and move around, the nurse will help him take out the chest tube and fix it. When the child is moving, the chest tube must be kept below the knees and sealed, and the swing range should not be too large.

Q7 How should the child cooperate when the doctor removes the chest tube?

Finally, the chest tube can be removed! Remember, when the doctor removes the tube, the child should take a deep breath and hold it to prevent the air from sneaking into the body. The doctor will also put a dressing on the wound where the chest tube was removed.

Q8 After the chest tube is removed, when can the stitches on the child’s skin be removed?

The stitches can be removed 10 to 14 days after the chest tube is removed, but before removing the stitches, the dressing on the wound needs to be changed every 3 to 4 days. If you sweat a lot, the time can be shortened to 1 to 2 days. Children should pay attention to protect the dressing on the wound and not let it come into contact with water.

Author: Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine

Wu Ying Xia Yuxian

Illustration: Zhang Xinran