13 Chest Tube Care

Skill 13

Chest Tube Care

A chest tube is a large catheter inserted through the thorax to remove fluid (effusions), blood (hemothorax), and/or air (pneumothorax). The location of the chest tube indicates the type of drainage expected. Apical (second or third intercostal space) and anterior chest tube placement promotes removal of air. Chest tubes placed low (usually in the fifth or sixth intercostal space) and posterior or lateral drain fluid (Fig. 13-1). A mediastinal chest tube is placed in the mediastinum, just below the sternum (Fig. 13-2), and is connected to a drainage system. This tube drains blood or fluid, preventing its accumulation around the heart. This skill reviews the nursing responsibilities and interventions related to the safe management of chest tubes. Review the roles and responsibilities of the health care provider for chest tube placement (Table 13-1). There are two types of commercial drainage systems: the water-seal and the waterless systems.

Fig. 13-1 Diagram of sites for chest tube placement.

Fig. 13-2 Mediastinal chest tube.

TABLE 13-1

Physician’s or Advanced Practice Nurse’s Role in Chest Tube Placement

Delegation Considerations

The skill of chest tube management cannot be delegated to nursing assistive personnel (NAP). The nurse directs the NAP about:

▪ Proper positioning of the patient with chest tubes to facilitate chest tube drainage and optimal functioning of the system.

▪ How to ambulate and transfer patient with chest drainage.

▪ Measuring vital signs and reporting to the nurse immediately any abnormal changes in vital signs, any complaints of chest pain or sudden shortness of breath, or excessive bubbling in water-seal chamber.

▪ The danger of any disconnection of system, change in type and amount of drainage, sudden bleeding, or sudden cessation of bubbling, and the importance of notifying the nurse immediately.

Equipment

▪ Prescribed chest drainage system

▪ Suction source and setup (wall canister or portable)

• Water-seal system: Add sterile water or normal saline (NS) solution to cover the lower 2.5 cm (1 inch) of the water-seal U tube. Or pour sterile water or NS into the suction control chamber if suction is to be used (see manufacturer’s directions)

• Waterless system: Add vial of 30 to 45 mL of sterile sodium chloride or water (for diagnostic air-leak indicator), 20-mL syringe, 21-gauge needle, and antiseptic swab

• Dry suction system

▪ Clean gloves

▪ Sterile gauze sponges

▪ Local anesthetic, if not an emergent procedure

▪ Chest tube tray (all items are sterile): Knife handle (1), chest tube clamp, small sponge forceps, needle holder, knife blade No. 10, 3-0 silk sutures, tray liner (sterile field), curved 8-inch Kelly clamps (2), 4 × 4–inch sponges (10), suture scissors, hand towels (3), sterile gloves

▪ Dressings: Petrolatum gauze, split chest-tube dressings, several 4 × 4–inch gauze dressings, large gauze dressings (2), and 4-inch tape or elastic bandage (Elastoplast)

▪ Face mask/face shield

▪ Sterile gloves

▪ Two rubber-tipped hemostats (shodded) for each chest tube

▪ 1-inch adhesive tape for taping connections or plastic zip ties

▪ Stethoscope, sphygmomanometer, and pulse oximeter

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Tags: Mosbys Pocket Guide to Nursing Skills and Procedures

Feb 19, 2017 | Posted by admin in NURSING | Comments Off

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