Reviewed by Charge Nurse Newborn

October 2007

Preparation of Equipment and Baby	Preparation of the Atrium Chest Drain	Diagram of the Atrium Drain
Connecting and Securing the Chest Drain		Ensuring the Atrium Drain is Functioning Correctly

Preparation of Equipment and Baby for Chest Drain Insertion - RBP

Step	Action
1	Dr/NS-ANP to wear mask, sterile gown and sterile gloves. Nurse to wear mask.
2	Analgesia should be routine except under emergency circumstances.
3	Open chest drain pack and add: chest trochar cannula appropriate for baby 3 way tap 10ml syringe Skin disinfectant appropriate for the infant's gestation and postnatal age 1ml syringe 25g needle
4	Have filter needle and 1 amp of 1% lignocaine ready for Dr/NS-ANP to draw up.
5	Wall suction unit.
6	Position baby supine and flat with affected side slightly tilted up (by using a folded nappy)
7	Set up Atrium chest drain.

Preparation of the Atrium Chest Drain - RBP

Step	Action
1	To fill water seal: Twist top off water bottle supplied and insert tip into suction port located on the top left-hand corner. Squeeze contents into water seal chamber (B) until fluid reaches the 2cm fill line. Once filled, water becomes tinted blue. Do not overfill this chamber. To remove excess water, aspirate with a syringe and needle via grey refill grommet situated on the back of the chamber. Remove funnel from suction control stopcock. Connect stopcock to suction tubing.
2	Dry suction regulator: The suction regulator (A) comes preset to -20cmH₂O. Using the dial located on the left side of the drain, dial down to -10cmH₂O.
3	Connect chest drain to patient prior to initiating suction. Connect suction tubing from suction source to suction port on top of chest drain.
4	Turn wall suction unit on. Adjust suction pressure as required to move bellows into window (E). Bellows do not need to reach the Δ mark for pressures less than -20cmH₂O.

Click on the image to see the Atrium set up

Step	Action
1	Chest drain is inserted. Dr/NS-ANP cuts end of drain to ensure tight fit to the 3 way tap.
2	The green Vygon connector fits on to the 3 way tap and on to the small pineapple (which comes taped on back of atrium pack) then on to the tubing of the atrium chest drain.
3	Chest drain is secured in place by either: small thin sleek gate dressing Tegaderm suture may be used
4	Ensure that any surplus tubing is coiled on the bed so that tubing hangs straight to the atrium drain.
5	The tubing from chest drain is secured to the bed by using tape and safety pin to ensure chest drain does not become dislodged.
6	X-ray will confirm correct position.
7	Document insertion of drain in multidisciplinary notes and on Level 3 nursing chart.
8	Ensure parent/s informed.

Follow the steps below at beginning of each shift to ensure atrium chest drain is functioning correctly.

Step	Action
1	Chest drain is taped securely.
2	Check for any oozing from drain site. (Inform Dr/NS-ANP.)
3	Tubing is taped and pinned to bed to prevent dragging and accidental disconnection.
4	The wall suction source is adjusted as required to maintain a movement of the bellows (E).
5	Check water seal is maintained at 2cm line, (fill to 2cm by syringe and rear grey refill grommet if below 2cm). Check the air leak zone. When bubbles are going from right to left in the air leak minotor (C) this confirms a patient air leak. DO NOT TURN OFF WALL SUCTION OR THE STOPCOCK WHEN CHECKING) Continuous bubbling confirms a persistent air leak Intermittent bubbling with float ball oscillating confirms the pressure of an intermittent air leak. No bubbling with minimal float ball oscillation at bottom of water seal will indicate no leak present.
6	If drainage is present in the collection chamber record the level on the chest drain chart (CR5586).

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