Pulmonary Concepts In Critical Care

Care of the Patient with Chest Tube

Pre Insertion

I. Assessment

  1. Assess patient's breath sounds, heart rate, blood pressure, temperature, respiratory rate and rhythm and O2 saturation.
  2. Assess patient allergies.
  3. Assure O2 and suction are available at bedside.

II. Intervention

  1. Instruct the patient regarding the purpose of the procedure, what to expect, and signs and symptoms to report.
  2. Administer ordered analgesia as needed.

III. Documentation

  1. Document in MIS or other approved Medical Records form.
  2. Document assessment (1 - 3).
  3. Document patient teaching.

Post Insertion, Maintenance and Post removal:

I. Assessment

  1. Immediately after insertion: A. insertion site, location and tube size
  2. Immediately after insertion and q 4 hours while chest tube is in place assess drainage collection system for:
    • A. fluctuations in the air leak indicator
    • B. air bubbles in the air leak indicator
    • C. suction set at ordered level.
  3. Immediately after insertion, q 4 hours while chest tube is in place, and immediately after removal of chest tube assess:

    A. comfort level
    B. breath sounds, heart rate, blood pressure, temperature, respiratory rate and rhythm and O saturation
    C. drainage for amount, color and consistency
    D. dressing for occlusiveness and drainage from insertion site
    E. chest wall at insertion site for subcutaneous emphysema

  4. While chest tube is in place and drainage collection system is in use

    A. Mark volume of drainage (date, time and initial) qs

II. Interventions

  1. Assure chest x-ray is obtained after insertion and after removal
  2. Verify patient knows potential complications (dyspnea, hemoptysis, etc.) and what to do should they occur
  3. Position the drainage system in upright position, below level of the heart at all times.
  4. Place emergency equipment in patient's room (bottle of sterile NS, 4 x 4, Vaseline gauze, tape & non-toothed padded clamps)
  5. Assure that extra drainage collection system is readily available on the unit
  6. Reposition patient q 2 hours
  7. Change dressing qd, or more frequently, if it becomes soiled, saturated, loose, or as otherwise instructed by prescriber
  8. Never clamp a chest tube, except momentarily, when:

A. changing the chest tube system
B. assessing for location of air leak
C. assessing patient's tolerance of chest tube removal

III. Documentation

  1. Document in MIS or other approved Medical Records form.
  2. Document assessment.

REFERENCES:

  1. Carroll, P. (1995). "Chest Tubes made easy". RN, December. pp. 46 -55.
  2. Gordon, P.A., Norton, J.M. & Merrell, R. (1995). Refining Chest Tube Management: Analysis of the State of Practice, Dimensions of Critical Care Nursing. 14 (1), pp. 6 -12.
  3. Kozier, B. & Erb, G. Eds. (1993). "Monitoring a Client with Chest Drainage". Techniques in Clinical Nursing. pp. 817 -821.
  4. O'Hanlon-Nichols. "Clinical Savvy: commonly asked questions about chest tubes". American Journal of Nursing. May 1996. 96, pp. 60-64.
  5. Springhouse Corporation (1991). "Chest Drainage", Procedures Video Series. Springhouse PA

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