Management of Chest Tubes Debbie Hogan RN Nursing 112

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Management of Chest TubesDebbie Hogan
RNNursing 112
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What is a chest tube?

• A chest tube is a large bore stiff catheter
  placed between the ribs into the pleura of a lung
  to relieve trapped air, blood or both.
• The resulting accumulation of fluid and or air
  places pressure on the lung. Therefore, the lung
  cannot expand for ventilation.

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More Chest Tube

• If the lung cannot ventilate, this results in
  dyspnea and altered ventilation-perfusion.
• A chest tube is placed near the affected lung
  area by a physician using local anesthesia.
• The removal of the air and or fluid allows the
  lung to re-expand.

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Indications for Chest Tubes

• Pneumothorax
• Hemothorax
• Trauma
• Surgery

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What Happens Next

• After the chest tube is inserted, the tube must
  be attached to a collection device.
• This is referred to as a chest drainage system.
• Dont forget the respiratory tract is sterile!!

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Chest Drainage System

• Usually has three parts
• Suction
• Collection
• Underwater seal

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Nursing Assessment of the Chest Tube

• Assess the patient
• Pulse ox/cyanosis
• Lung sounds/respiratory pattern rate
• Patient complaints of pain and or dyspnea
• Chest tube insertion site
• Color of chest tube drainage (if any)

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Assessment of the Chest Tube

• Is the chest tube attached to suction? If so how
  much?
• Is there movement of fluid in the tubing
  synchronous with respirations?
• Is there bubbling in the underwater seal?
• If the system is working properly, leave the room
  quickly!

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Problems with chest drainage systems

• Minimal problems-self contained systems
• Sometimes can clot
• Sometimes become disconnected
• Avoid sudden movement-punctured lung

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Nursing Responsibilities

• Assess
• Diagnose the problem with the chest tube
• May need to be milked occassionally
• Do not clamp the tube
• May need to be reattached
• Notify physician
• Document

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More Nursing Interventions

• Use pain meds judiciously
• Incentive spirometer/deep breaths-high risk of
  pneumonia
• Increase fluids if not contraindicated-thin
  bronchial secretions
• Encourage activity-up in chair _at_ bedside
• Antibiotic therapy is usually indicated

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Chest Tube Removal

• When lung has re-expanded, physician will remove
  the chest tube.
• Assess removal site
• Assess respiratory status
• Document

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Additional References

• Lewis pp. 588-592