Chest Tubes

• What is the purpose of chest tube insertion?

  • The purpose of chest tubes is to remove air, fluid, or blood from pleural or mediastinal space.  
  • The chest tube helps to restores negative intrathoracic pressure so that the lung can re-expand.   
  • Size & placement based on pt problem:  small tube for air; larger for fluid; 2nd ICS for air; 4-5 ICS for fluid. 
• What does a dry suction chest tube drain contain?

  • Contains 2 chambers; collection and water seal; suction controlled by regulator  
  • Indicator label shows ORANGE = suction is working  
• What does a wet suction chest tube drain contain?

  • Contains 3 chambers: collection, water seal, and suction [controlled by water level] 
• How do you interpret the water seal chamber in both dry and wet suction drain?

  • Both use water seal chamber to act as a valve to prevent backflow when pt inhales 
  • Bubbling in water chamber means there is still air leaking = BAD 
  • Tidaling is OK and means lung has not fully re-expanded; it will rise and fall with inspiration and exhalation  
  • No fluctuation may indicate blockage  
• How does the nurse assure adequate function of chest tube?

  • Suction set at ordered amount and working 
  • Evaluate activity in water seal chamber 
  • Assess color and amount of drainage ~ record I&O 
  • Notify MD of drainage > 70cc/hr 
• How does the nurse maintain drainage for a client with a chest tube?

  • HOB elevated 
  • Unit below chest; free of dependent loops  
• How does the nurse monitor insertion site for a client with a chest tube?

  • Assess for presence of subcutaneous emphysema (crepitus) ~ occurs when chest tube isn't fully in pleural space or air is leaking out into tissue 
  • Report if this is new and rapidly increasing! = monitor! 
  • Assure dressing is dry and intact ~ change everyday 
• How does the nurse monitor the respiratory status in a client with a chest tube?

  Monitor for sudden pain or dyspnea = return of the pneumothorax or tension pneumothorax 
• How does the nurse ensure no safety issues occur during the care of a client with a chest tube?

   

  • Assure all connection are taped 
  • Keep emergency supplies @ bedside [if some reason CT disconnects] 
  • Bottle of sterile water 
  • Vaseline gauze ~ if CT is pulled out cover it w/ 1 corner untaped = same as open chest wound 
  • clamps ~ only when there’s disconnect, and you cannot reconnect 
  • If you want to reconnect to drain; ask them to exhale and cough to get as much air out as possible then clamp = use rubber tipped clamps to protect tube  
• How do you determine when the client is ready for chest tube removal?

   

  • No bubbling in water seal chamber; no drainage 
  • CXR shows lung expansion 
  • Trial period of gravity or clamping 
• What are some nursing care done for chest tube removal?

  • Medicate the client 30 min prior to removal 
  • Site covered with occlusive dressing and non-porous tape 
  • CXR done after chest tube pulled ~ done to evaluate for recurrence of pneumothorax or fluid re-collection. 
  • Monitor for respiratory status  
• What is some education given to a client discharged with a chest tube?

  Report symptoms of...

  • Fever, cough, difficulty breathing 
  • Sudden sharp chest pain 
  • Redness, tenderness, drainage from CT site  
• You arrive to your patient's room and see their drainage system as been dislodged. What should you do to the distal end of the tubing?

  place in sterile bottle of water