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NUR 2744 Advanced Medical Surgical Nursing

Chest Tube Nursing Information and Care

Purpose: The purpose of a chest tube is to evacuate and collect air, and or fluid from the

chest cavity or the mediastinum.

Data to support: The visceral and parietal pleura form a potential intrathoriac space that is filled with approximately 4 ml. of lubricating pleural fluid. Between these two membranes, which line the chest wall and cover the lungs there is a fluctuating but always negative intrapleural pressure.

Disruption of the lungs, thorax, or pleura may be caused by disease, chest trauma, needle biopsy, surgery, or a thoracentesis and can enable air and of fluid to flow into the pleural space.

The insertion of a chest tube connected to a water seal or a one way drainage system restores normal respiratory function when the integrity of the pleural space is interrupted. The location of the device will be based on what the initial problem is.

If air must be drained-placement will be near the apex of the lungo Rationale-Free air will rise to the highest point

If fluid must be drained-placement will be near the base of the lung, usually in the 4th to 6th intercostal space.

o Rationale- Gravity will pull fluid down to the lung bases.

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Types of Chest Drainage Units-

Chest drainage unit (CDU): Traditional chest drainage unit consists of a collection chamber, water seal chamber, suction control chamber; can drain large amounts of fluid or air

Smaller/lighter portable CDU: Mechanical one-way valve instead of water seal chamber; good for patient who needs drainage only (not suction to reexpand lung), such as noncomplicated pneumothorax

Heimlich valve: Contains a one-way flutter valve; air drains out when patient exhales; keep collection device upright and vented to prevent air buildup

Indwelling pleural catheter: Drains chronic pleural effusions; drains fluid only; can be done at home every 1 or 2 days or when short of breath

Nursing Care of Chest Tubes and Chest Drainage Units-

Assessment- Patient- Entry Site- Patient Air Leak Meter Drainage Collection-

Clamping- This action requires a physicians’ orders. Reasons why you would clamp a chest tube are:

Clamp the tube only long enough to hook up another tube, to

prevent air from being sucked back into the chest.

Transporting-Always keep the collection chamber below the level of the insertion site.

Disruption- What if the chest tube gets pulled out by mistake?

Keep the Vaseline gauze by the bedside. Put the gauze onto the site of the chest tube insertion. Occlude the opening. you don’t want air going back into the patient’s chest. Call the physicians and get a state chest x-ray order..

Milking and Stripping-

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Stripping is controversial.. The idea is that if a chest tube is “milked” every couple of hours after, say, a surgical procedure, then it won’t get plugged up by clots, which only makes sense, since if the tube gets plugged, then the air and fluid that it’s supposed to remove will not get removed, and a tension situation could develop in the chest.

But stripping and milking can pull too hard suction-wise on the chest cavity, possibly causing tissue injuries to the lung. Consult with the physician about the action to take if this situation arises. If you’re instructed not to strip, watch carefully for signs that the chest tube is still working properly: draining air, fluid, or blood. If air were to stop coming out three hours postop a lobectomy , page the physician..

Dressing Changes-Consult your hospital policy and procedure for the schedule of dressing changes. Observe the site for drainage being careful to chart the color, amount, and type in your patients chart.

Trouble Shooting-There a few links listed below that you can refer to for more information on many types of chest tubes and the possible trouble shooting techniques. Please note that there are many different types of chest drainage units. It is important to always refer to your agencie’s policy and procedure for the current and correct ways to care for a patient with chest tube drainage.

For this reason we have attached one local area agency policies. See attached to this handout.

Please always know that your agencies policies will govern what you do.

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LINKS TO LEARN

Links for chest tube drainage learning.

http://www.teleflexmedical.com/ucd/nursing_considerations_troubleshooting.php

http://rnbob.tripod.com/chesttubecare.htm

http://books.google.com/books?id=SRcUYu--NLUC&pg=PA254&lpg=PA254&dq=care+for+a+patient+with+a+chest+tube+drainage+unit&source=web&ots=tvET-JQ5Ec&sig=ihPxWOISz_7EndRLW7WoAqK94Vw&hl=en&sa=X&oi=book_result&resnum=2&ct=result

http://www.righthealth.com/Health/Drainage_Tube_Chest/-od-definition_adam_1%25252F002947-s