Chest tubes are inserted to drain fluid or air from the pleural space and allow the lung to re-expand; they are connected to underwater seal drainage to maintain suction and allow fluid to drain via gravity while monitoring for fluctuations, bubbles, and output; nurses must carefully monitor patients with chest tubes and the drainage systems to ensure proper functioning and prevent complications.
2. is a flexible plastic
tube that is inserted
through the side of the
chest into the pleural
space to reexpand
the lung.
3.
4. Purpose
Itis used to remove air , fluid or pus.
To establish normal negative
pressure in the pleural cavity for
lung expansion.
To equalize pressure on both sides
of the thoracic cavity.
To provide continuous suction to
prevent tension pneumothorax.
5. Indication
Pneumothorax: accumulation of air
Pleural effusion: accumulation of fluid
Chylothorax: a collection of
lymphatic fluid
Empyema: a pyogenic infection of
the pleural space
Hemothorax: accumulation of blood
Hydrothorax: accumulation of serous
fluid
7. Pre Procedure
1. Confirm the procedure
2. Inform patient
3. Check for the consent
4. Prepare the equipments
5. X-ray (with the report to
determine the affected lung)
6. Position patient
8. Observe/monitor patient’s
Respiration
Saturation
Reduce patient’s anxiety
Prepare the under water seal
Connect the closed system fast
9. Post procedure
Monitor vital signs
15min x 1 hour
30mins x 1 hour
1 hour x 4 hours and until stable
Take note of the respiration
Rate
Pattern
Rhythm
Check saturation
Administer oxygen when necessary
10. Post procedure
1. Care of patient
Respiratory status
Auscultates lungs to assess air
exchange in the affected
lung
Place patient in fowler’s
position
11. Change the gauze when
necessary
Strict aseptic technique when
performing dressing
Check skin integrity
o Redness
o Swelling
o Loose suture
12. Intact and taped
Maintain patency
Check for obstruction
Teach patient on how to take care of the
tubing
Place a pillow between patient and tubing
Coil the tube
Avoid dependent loop
Instruct patient to cough if tube is blocked
Milking and stripping of the tube when
blocked
13. Use rubber tips
Clamped at the bedside
Clamping
During transfer
Not more than 1 minute
Upon doctor’s order
Note: clamping chest tube will accumulate
in the pleural cavity since the air has no
means of escape. This can rapidly lead to
tension pneumothorax.
14. 3 principles of under water
seal
Gravity
Water seal
Suction
15. Enhances flow from high to low.
Place below patient’s chest wall
(gravity)
Fill with sterile water.
Rod must be immersed 2cm in
water.
Observe for the fluctuation of
water level.
16. 5(a) Fluctuation
To ensure the patency of the
system
It will stop when :
lung fully expanded
an obstruction
Check for obstruction
Tubing –kinked
Patient’s position
Ask patient to take a deep
breath and cough
17. 5(b) Bubbling
Intermittentbubbling : normal
Continous bubbling : abnormal
Check :
Wound
Tube
Connection
If rapid bubbling without air leak :
inform doctor immediately
18. 5(c) Drainage output
70-100 mls per hour
observe for any change in
drainage colour
Mark the amount
Document in I/O chart
Change bottle every 24hours
or when full
19. 6. Suction apparatus
1. Low suction pump
Must be controlled
Suction valve / meter is inserted for wall
suction
Check for bubbling
If no bubbling
Clamp chest tube to check for air
leaks
Check tubing and connection
Observe patient’s condition while chest
tube is clamped.
20. 7. Safety
1. Tube
Prevent kinking
Place a pillow as barrier
Never clamp unnecessarily
2. Bottle
Must be below chest
Keep bottle in basin
Inform relatives and housekeeping
21. 8. Ambulation
Encourage patient to
change position to
promote drainage
No need to clamp the
tube
Maintain chest tube below
chest wall
22. 9. Exercise
Encourage deep breathing and
arm exercise.
On the first post op day.
When patient not in severe pain.
Assist patient.
To enhance the lung expansion
Prevent stiffness of the arm
23. 10. Comfort
Administer analgesic in the
first 24hours.
Allow position that
comfortable to the patient .
Assist patient in daily living
activity
Hygiene
24. Removal of chest tube
Assessment
X-raydone to check the
progress
Clamp for 2 hours
Chest tube removed
25. Emergency care
Bleeding
Observe wound dressing
Observe drainage
Dislodgement
From insertion site : place a
gauze immediately
From connection : clamp
chest tube immediately
26. Emergency care…
Bottle breaks
Identify either patient having
pneumothorax or hemothorax.
Observe patient for tension
pneumothorax.
Place tube in saline immediately.
Unclamped immediately. (prevent
respiratory distress)
Elevation of bottle
Immediately inform doctor