What to Do for Disconnected Chest Tubes?

A chest tube is a small drain inserted between the two layers of the pleura, the thin covering that protects and cushions the lungs and lines the inside of the chest cavity. The other end of the tube is attached to a drainage device placed below chest level, allowing the air or fluid to drain from the pleural space. A chest tube that is disconnected, either from the patient or from the drainage system, requires immediate attention.

Chest Tube Insertion

• Tube placement is determined by a chest X-ray.

  The insertion of a chest tube is a minor surgical procedure performed at the bedside by a licensed physician. The tube is inserted to restore intrapleural pressure and re-inflate the lung. A nurse or respiratory therapist is responsible for maintaining the patency (the ability for air or fluid to pass through) of the tube and the drainage system.

  The physician determines tube placement by assessing breath sounds and reviewing a chest X-ray. She will then make a small incision in the chest wall, insert one end of the chest tube and suture it in place. The other end of the tube is attached to a drainage system. A sterile four-by-four gauze pad covered in petroleum jelly is placed around the chest tube to make certain an adequate seal has been achieved. The physician will then tape the excess tubing to the patient's chest to prevent it from disconnecting from the suture site.

Disconnected from the Patient

• Chest tubes should be monitored regularly.

  If the chest tube becomes dislodged from the patient, apply a four-by-four gauze pad to the suture site and hold it in place. Notify the doctor immediately. Prepare for tube replacement by monitoring the patient's respiratory status. Release the pad periodically and at any sign of respiratory distress, so pleural air can escape.

Disconnected from the Drainage System

• A pleural effusion is fluid in the pleural cavity and often requires a chest tube.

  If the tube is still connected to the patient, but becomes dislodged from the drainage system, submerge the chest tube one to two inches below the surface of a 250 ml bottle of saline or sterile water while a new chest drainage unit is set up. This reestablishes a water seal, allowing the excess air and/or fluid to continue to drain and preventing the reentry of air into the pleural space.

  If there was constant bubbling in the drainage system prior to its becoming dislodged, indicating a continued release of air and fluid from the pleural space, do not place the tube in water. It is better to allow a small amount of air into the system than to eliminate the drainage.

  All drainage systems have a negative pressure indicator that should be in the green or YES zone. If at any time the indicator is not green or YES, and the tubing is still connected to the patient and the system, replace the system.