Chest Tube: Set-up, Measurements, Management

Critical Elements

• Maintain sterile technique.
• Maintain safety of patient at all times.
• Apply correct amount of suction if ordered.
• Pre and post procedure respiratory assessment.

Procedure

Prior to Treatment: (Critical Thinking)

• Assess patients need for treatment.
• Gather equipment: disposable water-seal system, suction, sterile water or normal saline, syringe, and two rubber tipped clamps.
• Consider administration of pain medication.

Patient Interaction: (Safety)

• Patient identifiers.
• Provide for privacy.
• Explain procedure.
• Confirm allergies.
• Wash hands.
• Medicate if needed.

Steps of the Procedure: (Patient Centered Care)

Set up Wet Suction

1. Set up suction equipment.
2. Open package of disposable water-seal system.
3. Remove cover on the water-seal chamber, using the funnel provided, fill the water-seal chamber with sterile water or normal saline to the ";fill line";.
4. Place the drainage system upright at least 1 foot below the client"s chest level.
5. Replace the cover on the water-seal chamber.
6. Attach the tubing from the suction-control chamber to the connecting tubing attached to the suction source.
7. Turn on the suction to the appropriate amount to active ordered suction.

Set up of Dry Suction

1. Set up suction equipment.
2. Open package of disposable water-seal system.
3. Place drainage system at least 1 foot below the patient chest level.
4. Attach the tubing from the suction-control chamber to the connecting tubing attached to the suction source.
5. Fill a syringe with 45 mL of sterile water or saline. Fill the air leak monitor on the water-seal system by injecting the fluid into the needleless injection port on the back to the fill line.
6. Turn on the suction to the appropriate amount to active ordered suction.

Measurements and Management

1. Assessment: crepitus, respiratory, chest tube insertion site/dressing, air leak and drainage amount and character.

Dressing the Chest Tube after Placement

1. Gather equipment: sterile gloves, petroleum gauze, sterile drain dressing, large drainage dressing, tape.
2. Confirm that the drainage tube lies with no kinks from the chest tube to the drainage chamber.
3. Apply sterile gloves.
4. Using sterile technique, wrap petroleum gauze around the chest tube insertion site.
5. Place pre-cut drain dressing over the petroleum gauze.
6. Place a second sterile, precut drainage dressing over the first with the opening facing in the opposite direction.
7. Place a large drainage dressing over the two precut drainage dressings.
8. Secure the dressing in place with tape, make sure to cover the dressing completely.
9. Write date, time and initials on the dressing.

After Procedure (Patient Centered Care)

• Place 2 rubber tipped clamps and petroleum gauze dressing at bedside in case of emergency.
• Prepare for a portable chest x-ray.
• Position the patient for comfort with head of bed at least 30 degrees.
• Straighten room making patient comfortable, replace call light.
• Wash hands before leaving room.

Document (Informatics, Communication)

• Size, type, location of tube placed.
• Status of drainage removed.
• Assessment before and after the procedure.
• How patient tolerated the procedure.

Resources

• Closed Chest Drainage