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Outline
Overview
- Chest tube is inserted through chest wall into pleural space, in order to:
- Drain fluid, blood, or air
- Pleural Effusion
- Hemothorax
- Pneumothorax
- Post-Op drainage
- Establish negative pressure (one-way valve)
- Facilitate lung expansion
- Drain fluid, blood, or air
Nursing Points
General
- Setup
- Chest tube – varying sizes
- Holes in end
- Secured with suture
- Drainage system
- Tubing
- Collection chamber (2000 mL with markings)
- Water seal chamber (should be at 2 cm level)
- Port on back to add sterile water
- Suction pressure dial
- Suction port
- Will need suction tubing
- Foot to prevent tipping
- Hangers to keep off floor
- Occlusive Dressing
- Must remain upright, below chest
- Chest tube – varying sizes
Assessment
TWO AA’S
- Tidaling
- Movement of fluid with breaths
- Rise with inspiration
- Fall with expiration
- Could be normal
- NO tidaling = re-expansion or obstruction (assess)
- Movement of fluid with breaths
- Water seal level
- Should be at 2 cm at all times
- Add more sterile water if needed
- Output
- Quantity
- Measure every 4 or 8 hours (per facility policy)
- Mark on chamber
- Report increased volume (per provider orders)
- Quality
- Color
- Sanguineous
- Serosanguinous
- Serous
- Character
- Purulent
- Clots
- Report unexpected finding to provider
- Color
- Quantity
- Air leak
- Continuous bubbling in water seal chamber
- May indicate:
- Pneumothorax
- Dislodgment
- Disconnection
- Equipment failure
- Ability to breathe
- Always assess the patient (not just the system).
- Shortness of breath? Pain?
- SpO2
- Determine oxygenation status
Therapeutic Management
- Complications
- Air Leak
- Indicates air getting into the system
- Cross-Clamp technique to find the leak
- May have to change whole system
- If chest tube or site are source — call provider
- Dislodged/Removed (accidentally)
- Apply 3-sided occlusive dressing immediately
- Call provider
- Air Leak
Nursing Care
- Coil tubing in bed
- NO dependent loops
- Do NOT clamp except:
- Troubleshooting air leak
- Specific instructions from provider
- Could cause Tension Pneumo
- Do NOT strip (pull fingers along tube to move drainage down)
- Causes increased negative pressure
- Could cause tissue damage
- Squeeze gently, instead
- Keep system upright and below chest
- Keep at bedside:
- 2 hemostat clamps (for cross-clamping)
- Sterile water / syringe for water seal
- Occlusive dressing & tape
Patient Education
- Importance of not pulling on chest tube
- Also not to get out of bed without help
- Purpose for chest tube
- Explanation of procedures (NOT informed consent)
- Splinting with deep breaths or coughing.

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