Definition
A chest tube is inserted in thoracic cavity to maintain respiratory function and hemodynamic stability of a patient.
Indications
- To treat pleural effusion, pneumothorax, hemothorax, pneumohemothorax, and empyema.
- To facilitate lung expansion in postoperative lung resection patients.
Articles
- Drain clamps: 2 Nos. (to use in emergency only).
- Two suction outlets: One for chest drain and another for airway management.
- Containers for collecting drainage specimens for culture through needleless sampling port located by the inline connector.
Procedure
| Nursing action | Rationale | |
| 1. | Upon receiving the patient in the postoperative unit, assist him/her to a position of comfort giving special attention to the placement of chest tube. Ensure that the drainage tube is sutured to the patient’s skin at the entry site. | To guard against the risk of the tube falling out or sliding in and out through the skin. |
| 2. | Assess respiratory status at least every 4 hours. | Frequent assessment is necessary to monitor respiratory status and the effects of chest tube. |
| 3. | Secure chest tube to the chest wall and tubing to the patient’s bed. | In order to prevent inadvertent tube removal and pulling of the drain. |
| 4. | Ensure that all connections between chest tube and drainage unit are tight and secure. | To maintain the drainage system intact. |
| 5. | Keep the collection apparatus below the level of chest. | Pleural fluid drains into the collection apparatus by gravity flow. |
| 6. | Attend to the patient’s comfort and sedation needs as per procedural guidelines. Perform periodic pain assessment for the duration of chest drainage. | To reduce pain and discomfort in the chest and at the chest tube insertion site. |
| 7. | Perform periodic patient assessment. PICU and NICU patients should be on continuous monitoring. Check the patient’s heart rate, peripheral capillary oxygen saturation (SpO₂), BP, respiration rate, and chest drainage. | Enables early and timely management for any complication that may occur. |
| 8. | Check the water-seal of the drainage system frequently. The water level should fluctuate with respiration. | The system may not be intact, if there is no fluctuation. |
| 9. | Check the tube frequently for kinks or loops. | These could interfere with proper drainage. |
| 10. | Ensure periodically that the drainage tube is submerged to a depth of 2 cm in water of the collection chamber. | Ensures water-seal system. |
| 11. | Ensure that periodic air bubbles occur in the water-seal chamber. | Indicates trapped air is being removed from the chest and the system is functioning. |
| 12. | If a high volume, low pressure system is used, make sure that it is with 5 kpa of suction. | To avoid serious complications. |
| 13. | Measure the drainage every 8 hours, marking the level on the drainage chamber bottle. Report drainage that is cloudy, in excess of 70 mL/h or red and free flowing. | Red, free flowing drainage indicates hemorrhage. Cloudiness indicates infection. |
| 14. | Assist patient with frequent position changes, sitting and ambulation as allowed. | Prevents inadvertent disconnection or removal of tube. |
| 15. | When chest tube is removed, immediately apply a sterile, occlusive, petroleum jelly dressing. | An occlusive dressing prevents air from entering the pleural space through the wound. |
Special considerations
- Patient positioning: If a patient is on strict bed rest or is an infant, regular change of position is encouraged to promote drainage unless clinical condition prevents doing so.
- Patient transport: If the patient with chest tube and suction needs to be transported, to another department or ambulance, the suction should be disconnected.
Clamping of the tube should be done whenever the patient is at risk of having air or fluid entering the pleural space.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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