Chest tubes

What conditions are they used for

Used when negative pressure in the pleural space is disrupted

Fluid in the lungs (pleural effusion)

Blood in the lungs (Hemothorax)

Air (pneumothorax)

Where do they go in the body

Depends where the problem is

• If it’s air it usually goes in the top part of the lung because air rises

• Fluid or blood it would go in the bottom of the lung because it won’t rise

How do they work

It’s pressure and suction the internal suction will pull it into the chest tube container think of it like a giant straw it will suck all the fluid into the container to get all the fluid out

If ordered for suction you need to turn the suction on the tube itself (need to turn the dial up)

Water-seal chamber (one-way valve)

Water seal is just working on the water that is inflated into the pleural space, think of it like a foley balloon but it a chest tube, the water goes into the container

Tidaling- is when the water moves up and down with the breaths that’s a good thing

Intermittent bubbling- in the water seal chamber is normal

If continuous bubbling that means there is an air leak

• The origin must be located quickly

• Search the tubing and connection completely as the drainage system may require replacement, first thing to check is the insertion site of the tube

Suction

If drainage produced is inadequate, encourage the patient to cough and reposition

Continuous gentle bubbling in the suction control chamber is normal

Vigorous bubbling does not increase suction; only causes H2O to dissipate more quickly

What are the nurse’s responsibilities for a chest tube patient

Including assisting with insertion, monitoring the patient’s status and response to the treatment, monitor the patency of the chest drainage system, patient education, and assisting with removal of chest tube

Once tube is in place monitor the patient’s response, including respiratory status and vital signs, check the site and site dressing, and maintain patency and integrity of the drainage system

How to handle a dislodged chest tube

Immediately place gloved hand over insertion site and call for assistance

Secure occlusive Vaseline dressing over the insertion site with tape (3 sides)

Reassess the patient or otherwise contaminate within tubing

How to handle a tubing disconnected or otherwise contaminated within the tubing

Clamp the chest tube

Irrigate the contaminated tubing with saline or sterile water and place end of tubing at least 2-4 centimeters into the solution and unclamp

Stay with the patient while another nurse obtains and connects a new collection system

How to handle when there is no fluctuation in water seal chamber

Reposition the patient and encourage coughing and deep breathing

Check the tubing to assess for obstructions or kinks

Remember that fluctuation will naturally decrease or stop as the lung re-expands