CHEST TUBE

CARE

By: Vanessa Morton, Student Nurse

Front Range Community College

Senior Practicum Teaching Project

Chest tube basics

What are chest tubes?

flexible plastic tubes

inserted through the side of the chest and

into the pleural space

used to drain contents from the

intrathoracic space

tubes are connected to A

chest drainage canister

Chest tube basics What is a drainage canister?

a drainage canister is

typically used to collect

chest tube contents (air,

blood, or effusions)

can hold up to 2000 ml of

fluid

Typically there are three

chambers: the drainage

collection chamber, the

water seal chamber, and

the suction control

chamber

Can be connected to

suction or can be used

with gravity

Needs to stay below the

level of the patient’s

chest

Chest tube basics

When are chest tubes used?

After surgery or trauma

Pneumothorax

hemothorax

Air leaks from the lung into the chest

pneumothorax

Bleeding into the chest

hemothorax

Collection of fat in the chest

chylothorax

Lung abscesses or pus in the chest

empyema

Pneumothorax

a collection of air or gas in the pleural cavity

of the chest between the lung and the chest

wall

Hemothorax

a condition that results from blood

accumulating in the pleural cavity

Chylothorax

a type of pleural effusion resulting from

lymphatic fluid (chyle) accumulating in the

pleural cavity

Empyema

a collection of pus within a naturally existing

anatomical cavity, such as the lung pleura

More about drainage canisters

One-bottle system

simplest set up

first tube submerged

in 2 cm water creates

a water seal

second tube

connected to wall

suction

excessive

accumulation of fluid

can cause decreased

function of the unit

More about drainage canisters

Two-bottle system

separate bottles for

collecting drainage

and for the water seal

air from the pleural

space travels from the

collecting bottle to

the water seal bottle

and exits into the

atmosphere

separate bottle for

drainage means more

fluids can be collected

before a new bottle is

needed

More about drainage canisters

three-bottle system

separate bottles for

collecting drainage,

for the water seal,

and for suction

control

level of fluid in the

suction control

bottle determines the

amount of suction

provided

rarely used due to

bulkiness

More about drainage canisters

Plastic Multi-Chamber

System

Commercially available

Incorporates the three

bottle system into one

unit

Plastic Multi-Chamber System

• Three separate chambers

– Drainage collection chamber

– Water seal chamber

– Suction control chamber

Drainage collection chamber

Water seal chamber

Suction control chamber

Chest tube site care

dressing changes

• vary depending on each facility’s

policies and procedures

However, dressing changes

are always completed using:

• Sterile technique

• An occlusive dressing

Supplies always

Kept at the bedside

sterile normal saline

Used If tubing gets disconnected

submerge the end of the chest tube

(1 to 2 inches or 2-4 cm) below the surface of sterile

normal saline to establish a water seal, allowing air to

escape and preventing air from re-entering

petroleum gauze

used to cover the chest incision if the tubing is

accidently removed

allows air to escape from the incision, and prevents air

from entering the incision

depending on the facility’s policies and procedures, 3 or

sometimes all 4 sides of the gauze can be taped down to

the patient’s skin

If you think something is

wrong…

Always assess the patient first…then the equipment!

-check for signs of respiratory

Distress

-assess level of chest pain

-listen to lung sounds

If you think something is

wrong…

Always assess the patient first…then the equipment!

-check the patient’s heart rate

-check the patient’s dressing

-check the drainage system,

The tubing, and the suction

When should you call the

doctor?

-Any signs of increased respiratory distress

-New onset or worsening crepitice

-Signs of a clogged chest tube (blood clot in tube)

-Hypovolemic shock

-Any signs of increased air leakage

-Greater than 100 cc of drainage in one hour for two or

more hours

-Worsening vital signs (increased heart rate,

respiratory rate, temperature)

References

Cabggroupassignment.wikispaces.com, (2011). Care of a Patient With a Chest Tube. Retrieved from http://cabggroupassignment.wikispaces.com/Group+Three+- +Care+of+a+patient+with+chest+tubes

Hkresp.com, (2009). Nursing Management of Chest Drains. Retrieved from http://www.hkresp.com/index.php/administrator/152-pleural-diseases/578-2009-dec- nursing-management-of-chest-drains

Respiratorytherapycave.blogspot.com, (2011). Chest Tubes and Pleural Drainage Systems. Retrieved from http://respiratorytherapycave.blogspot.com/2011/10/chest-tubes- and-pleural-drainage.html