2. Chest tubes
A chest tube is a hollow, flexible tube placed into the
chest and acts like a drain
Chest tubes drain air, fluid, bile, pus, or blood around
your heart, esophagus, or lungs
The tube is inserted around your lung through your rib
cage and into the space between the inner lining and
the outer lining of your chest cavity called the pleural
space
The purpose of a chest tube is to allow the lungs to fully
expand
3. Types of Chest tubes
Large (36F to 40F) tubes used to drain blood
Medium (24F to 36F) tubes used to drain fluid
Small (12F to 24F) tubes used to drain air
Pigtail tubes are very small (10F to 14F) with a curly
end designed to keep them in place
5. Chest drainage unit
First compartment (collection chamber) receives fluid and air
from the pleural space
Second compartment (water-seal chamber) contains 2 cm of
water, which acts as a one-way valve
Tidaling – normal flunctuation of the water within the water-seal
chamber and reflects respirations on inspiration and expiration
The air enters from the collection chamber and bubbles up
through the water
Third compartment (suction control chamber) applies
suction to the chest drainage system
Two types: water and dry
6. Chest tube indications
Pneumothorax
Hemothorax
Empyema
Pleural Effusion
Hemopneumothorax
Hydrothorax
Chylothorax
Patients with penetrating wall injury who are intubated or
about to be intubated
7. Chest tube insertion
Make sure patient is aware of the procedure and
informed consent is obtained
Gather equipment
Thoracotomy tray
Chest drainage unit (CDU)
Chest tube
Bottle of sterile water
1% lidocaine
Suction tubing and collection container
Occlusive dressing
8. Chest tube insertion (cont..)
Prepare CDU
Wet suction: add sterile water to 2-cm mark in water-seal
chamber and to 20-cm mark (or as ordered) in suction
control chamber
Dry suction: add sterile water to the fill line of the air leak
meter. Attach suction tubing and increase suction until the
bellows-like float moves across the display window
Position and support the patient to minimize movement
during procedure
10. Risks and complications
Bleeding or infection where the tube is inserted
Improper placement of the tube (into the tissues,
abdomen, or too far into the chest)
Injury to the lung
Injury to organs near the tube (spleen, liver, stomach,
or diaphragm)
11. Nursing considerations
Assess vital signs, lung sounds and pain
Assess for manifestations of reaccumulation of air and fluid in the chest (decrease or absent breath
sounds)
Assess for significant bleeding (100 mL/hr)
Assess for chest drainage site infection (drainage, erythema, fever, increase WBC) or poor wound
healing
Encourage patient to cough and breath deeply
Make sure connections are taped securely
Keep collection below the level of the patients chest
Check water seal and suction control chambers
Measure drainage every 8 hours or more often depending on patients condition
Document assessment of drainage system and how patient is responding
12. Care of chest tube and
drainage unit
Mark the time of measurement and the fluid level on the drainage unit according to
the unit standards
Keep all tubing loosely coiled below the clients level
Observe for air flunctuations (tidaling) and bubbling in the water-seal chamber
Keep the suction control chamber at the appropriate water level by adding sterile
water as needed
If no bubbling is seen in the suction control chamber, there is no suction, suction is
not high enough, or the pleural air leak is so large that suction is not high enough to
evacuate it
13. Removing the chest tube
Chest tubes are removed when:
The lungs are reexpanded and fluid drainage has ceased
or is minimal
The suction is discontinued and the chest drain is on
gravity drainage for 24 hours before removed
15. Procedure chest tube removal
The physician or an advanced practice nurse in most settings
will remove the tube
Give patient pain medications about 30 minutes before
Gather dressings and supplies and petroleum jelly
Explain procedure
The suture is cut, and a sterile airtight petroleum jelly gauze
dressing is prepared
With the patient holding his or her breath or bearing down
(Valsalva) the tube is removed
The site is covered with airtight dressing
A chest x-ray is done to evaluate pneumothorax or
reaccumulation of fluid
Assess wound for drainage and patient for respiratory distress
16. References
Tube Thoracostomy. (2017,August 18). Retrieved November
22, 2017, from https://emedicine.medscape.com/article/80678-
overview#a9
Chest tube insertion. (n.d) Retrieved Novemeber 22, 2017, from
https://medlineplus.gov/article/002947.htm
A novel technique for chest drain removal using a two layer
method with triclosan-coated sutures. (n.d.) Retrieved
November 23, 2017, from
https://jtd.amegroups.com/article/view/11552/html
Dirksen, S.M., Heitkemper, M.M, Bucher, L., & Lewis, S.M.
(2014). Clinical companion to Medical-surgical nursing:
assessment and management of clinical problems. St. Louis,
MO: Elsevier.
