How to Manage Chest Tubes

Chest tubes are commonly placed in hospital patients who have suffered trauma to the lung, such as a gunshot wound or surgical incision. This creates a pneumothorax, or "collapsed lung." Chest tubes allow the lung to re-expand, and are also used to drain excessive blood and fluid from the chest cavity, especially after cardiac surgery. The chest tube is inserted by a physician, but it's up to the patient's nurse to manage the tube and be alert to possible complications.

Things You'll Need

• Sterile chest tube setup
• Silk tape
• Occlusive dressing
• Wall suction canister and tubing
• Stethoscope
• Vital signs monitoring equipment

Show More

Instructions

Chest Tubes in General

• 1

  The chest tube system is essentially the same, regardless of brand. The part of the chest tube that is actually inside the patient is attached to a six-foot length of flexible tubing that connects the tube to the drainage system.

  Most modern drainage systems comprise three chambers housed in a single plastic unit. One chamber collects fluid, a second is a water seal or one-way valve that lets air leave the pleural space and prevents air from getting in, and the third is a suction control chamber or valve that regulates the negative pressure applied to the chest, or the amount of suction used. The suction control is determined by the setting on the drainage system, not on the vacuum setup on the wall.

• 2

  Immediately after placing a new chest tube, the doctor should order a portable chest X ray to confirm proper placement. To keep the drainage unit from turning over, securely tape the base to the floor. The nurse should verify that suction is set to tbe amount ordered by the physician. The most common setting is -20cm H20, the default setting on most chest-tube drainage units.

• 3

  The nurse should check for air leaks every two hours or as ordered by the physician or by facility protocol. Intermittent bubbling may occur soon after the tube is placed; this is normal at first and decreases as fluid is drained off. Constant bubbling indicates an air leak. The location of the leak can be determined by clamping the tube near the patient and working down until the bubbling stops. If bubbling continues, the tubing leading to the wall suction should be clamped. Be sure that tubing is firmly attached at all connectors. Continued bubbling indicates that the drainage unit may be cracked, or that the tubing could have a puncture. If bubbling cannot be resolved, the physician should be notified.

Assessing the Patient

• 4

  Monitor the patient's vital signs every two hours or as directed by facility protocol. This check should include oxygen saturation levels and breath sounds. Watch for increased respiratory rate, labored breathing, or dropping O2 sats. Assess breath sounds and note any changes. Check the chest tube site dressing to be sure it is dry and intact. Change dressing only if it becomes soiled. Monitor patient's pain level and give pain medication as indicated.

• 5

  If patient leaves the floor or is unattached from tubing for any reason, check to see that connectors are firmly in place. Do not milk or strip the tube unless to remove a blood clot or tissue fragment. Gently manipulate the tube to drain matter and prevent it from becoming occluded.

• 6

  The amount of drainage from chest tubes should decrease over time. Notify the physician if drainage is greater than 100 cc per hour. Assess output every two hours after initial placement for the first four hours. Mark drainage level on the unit each time output is charted, typically at the end of the shift.

• 7

  If the patient pulls out the chest tube, the nurse should cover the site with a sterile occlusive dressing and notify the physician immediately. He or she should stay with the patient and monitor respiratory status while another nurse prepares to place a new tube. If the chest tube has been in place for a while and has little output, the physician may order a chest X ray to evaluate the lung expansion before placing a new tube.