Definition
Chest tube insertion is a procedure done to drain out air, fluid, pus, or lymphatic fluid from the pleural space, thereby regaining the negative pressure within the pleural space to help re-expand the lungs.
Indication
- Pneumothorax (open and closed).
- Hemothorax.
- Tension pneumothorax.
- Hemopneumothorax.
- Pleural effusion.
- Chylothorax (A type of pleural effusion).
- Penetrating chest trauma.
- Pleural empyema.
- Followed by open heart surgeries.
Purpose
- To drain air or serosanguinous fluid from the pleural space.
- Restore normal pulmonary ventilation.
- Re-establish negative pressure in the pleural space.
- Prevent mediastinal shift and lung tissue collapse.
Articles
A thoracotomy tray (obtained from OR, CSSD or ICU”) containing the following:
- Scalpel and haemostats.
- Chest tubes (size 24-32 for normal adults or 36-40 for large adults).
- Suture material.
- Vaseline gauze for occlusive dressing.
- Dressing material
- Dry seal drainage system or under water seal drainage unit as per hospital policy.
- Sterile drapes.
- Injectable lidocaine.
- Antiseptic to clean the skin.
- Sterile gloves.
*OR: operating room; CSSD: central sterile services department; ICU: intensive care unit
Procedure
| Nursing Action | Rationale | |
| 1 | Before procedure Ensure that the patient is a candidate for emergency procedure. | In emergency situations, the procedure may be done at the bedside. |
| 2 | Explain to patient and/or family the need for the procedure and what is being expected. | Assists in gaining confidence and reducing anxiety. |
| 3 | Obtain informed consent from patient or next of kin unless physician does it as a medically necessary emergency procedure. | Informed consent is required for any invasive procedure to avoid legalities. |
| 4 | Provide adequate privacy. | Maintains dignity of patient. |
| 5 | Assess and document patient’s vital signs including temperature, heart rate, blood pressure and oxygen saturation, Ensure continuous monitoring during procedure. | Helps assessing changes in patient’s health status and intervene appropriately. |
| 6 | Position the patient in supine with arm above the head on the affected side. | Proper positioning assists with access to site. |
| 7 | During procedure Administer oxygen if patient is not already intubated. | Reduces difficulty in breathing. |
| 8 | Administer analgesia or sedation as ordered. | Ensures comfort of patient. |
| 9 | Prepare the tube insertion site following aseptic precautions. | Prevents infection. |
| 10 | Drape the patient using sterile drapes. | Ensures aseptic precautions. |
| 11 | Prepare the intercostal drainage (ICD) system as explained in the procedure. | Proper ICD drainage prevents air from entering pleural space |
| 12 | When physician inserts the chest tube, attach the connecting tube to the intercostal drainage system that is prepared. | Ensures water-seal drainage and prevents air from entering pleural space. |
| 13 | After physician applies sutures to hold the chest tube, apply a sterile, occlusive dressing around the chest tube site. Apply Vaseline gauze around the chest tube site closing off the skin around the chest tube. Apply a drain sponge (4×4) around the chest tube. Following it, place a slit drainage pad, and a 4 x 4 gauze on top. With a 3–4-inch tape, secure the dressing with an airtight seal. | Ensures proper seal and prevents air from entering pleural space. |
| 14 | Ensure proper drainage through chest tube. | Ensures removal of fluid from pleural cavity. |
| 15 | After procedure Wash hands, dispose of waste, and clean the reusable articles. | Prevents cross-contamination. |
| 16 | Document the procedure carried out, patient’s health status, fluid drained, and water-seal pressure applied. | Serves for communication among medical staff. |
Possible complication
- Bleeding into the pleural space.
- Subcutaneous emphysema.
- Infection.
- Injury to lung
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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