Closed thoracic drainage is the most common procedure in thoracic surgery, and this procedure may be a step in the process of major thoracic surgery, as closed thoracic drainage is attached to almost all patients after thoracic surgery, and patients leave the operating room with a chest drainage bottle. Closed thoracic drainage can also be used as a separate procedure to treat disease. Nurses in thoracic surgery and the families and companions of thoracic surgery patients inevitably face the care of a closed chest drainage device. Purpose of closed thoracic drainage 1.Drainage of fluid or gas in the chest cavity 2.Restoration of negative pressure in the thoracic cavity and maintenance of the normal position of the mediastinum. 3.Promote lung reopening and prevent lung infection. Pre-operative guidance: 1. Quit smoking and alcohol. Smoking has the greatest impact on the recovery of surgery, especially on the recovery of extra-thoracic surgery, so complete cessation of smoking is necessary. 2, respiratory function exercise, effective respiratory function exercise before surgery is one of the important measures to prevent lung infection and promote lung resuscitation. Except for emergency surgery, all patients should perform respiratory function exercise before surgery within their ability. Method: Do deep breathing exercises in an environment with relatively good air quality, breathing at a rate of about 10 breaths per minute, for 3 to 5 minutes per cycle, 3 to 5 cycles per day. Walk slowly, climb hills or stairs. Do chest expansion exercises. Nebulizer inhalation and active and effective coughing. Post-operative position Try to adopt a semi-leaning position with the head of the bed elevated at an appropriate angle (30 degrees to 60 degrees) to facilitate the outflow of fluid in the chest cavity and also facilitate respiratory and circulatory functions, and also to reduce wound tension and pain. Drainage tube care 1, the drainage tube inserted into the chest cavity is usually fixed on the chest wall with 2 stitches of silk suture, and should not be excessively stretched or bent to prevent dislodgement of the chest cavity or fracture. 2, there is a connecting tube between the chest drainage bottle and the chest tube, one end of the connecting tube is connected to the chest tube inserted into the chest cavity, and the other end is connected to the long tube inside the drainage bottle. Must ensure that the two joints are tightly connected, not leaking, not disconnected. 3, the fluid level of the drainage bottle should be at least 60 cm below the level of the chest cavity, so as to ensure that the fluid in the drainage bottle will not back up or be inhaled into the chest cavity. So the drainage bottle should be placed on the ground next to the bed, not above the ground hanging on the side of the bed or on the bed or seat. 4, the drainage bottle must be placed in a stable position, can not be tilted, let alone dumped. In order to prevent the bottle from tipping over, the bottle should be placed under the bed that is not easily touched, and open the bottle base bracket to increase stability. 5, the tube must be connected to the long tube inside the drainage bottle, and the lower end of the long tube must be 2 to 3 cm below the liquid level so that the atmosphere can be separated from the chest cavity by the action of the water seal. The lower end of the long tube is best at 2 to 3 cm below the level of the fluid, too shallow to play a sealing role, too deep drainage effect is poor. So if there is too much liquid in the drainage bottle, you must always pour off the excess liquid. 6, the drainage tube should be kept open to prevent blockage, distortion, pressure. You can judge whether the drainage tube is open by observing the fluctuation of the water column in the long tube of the drainage bottle, if the water column fluctuates up and down with breathing and coughing indicates openness, if the water column does not fluctuate, coughing hard also does not fluctuate, it is likely that the drainage is not open. Often squeeze the chest tube, change the position can prevent the drainage tube blockage. 7, carefully observe the quality and quantity of drainage and keep records. After surgery, there is usually gas or blood drainage, which is normal, do not be nervous. However, if there is a large amount of gas overflowing from the drainage bottle (manifested as bubbles) and the patient’s respiratory distress does not improve, it is a critical situation and should be reported to the doctor in time. If there is a large amount of blood flow in a short period of time, it should also be reported promptly and without delay! In general, the amount of blood drained per hour is less than 200 ml, and gradually decreases, the color gradually becomes lighter, the patient’s vital signs are stable, and can be observed. If the drainage volume is greater than 200 ml per hour and lasts for 3 hours or the vital signs are unstable, immediate open-heart surgery is required. Cough and sputum instruction: encourage the patient to breathe deeply and cough actively to facilitate the discharge of deep tracheal sputum and the accumulation of air and fluid in the thoracic cavity, so that the lung can be reopened. When coughing up sputum, help the patient sit up and pat his back and instruct him to cough after deep inspiration. For elderly patients who are unable to cough, press the incision with one hand and press the middle finger of the other hand at the superior sternal fossa to stimulate the main bronchus to cause cough reflex to help them cough up sputum effectively. Guidance when getting out of bed Early on, advise the patient to turn over in bed and move their limbs. In principle, the earlier the patient gets out of bed, the better the patient’s recovery will be. When turning out of bed, teach the patient to actively hold the drainage tube with one hand to prevent dislodgement. When walking with the drainage bottle, the bottle should be suspended by a strap to facilitate the patient to carry the bottle. When standing and walking, keep the upper edge of the chest drainage bottle below the knee joint, keep the bottle in an upright position, and always keep the fluid level of the bottle below the chest cavity by more than 60 cm to ensure that the fluid in the drainage bottle does not back up. Thoracic drainage tube off the fall treatment: drainage tube from the chest wall wound slipped off, should immediately use the palm of the hand to compress the wound or hand pinch closed the skin at the wound, promptly reported to medical personnel to deal with.