Avantae L. Cruz, RN, BSN CHEST TUBES Do’s and Don'ts
Avantae L. Cruz, RN, BSN Chest Tube Purposes To remove solids, liquids, and/or gases from the pleural space This allows for lung re-expansion
Avantae L. Cruz, RN, BSN Chest Tubes Always keep below chest level NEVER clamp NEVER routinely milk MD should be notified and order obtained
Avantae L. Cruz, RN, BSN Chest Tube Maintenance Assess dressing q.48 hours and PRN Mark hourly shift increments include date and time Check and maintain tube patency q.2-4 hrs. fluctuation of fluid in tubing indicates patency
Avantae L. Cruz, RN, BSN Chest Tube Maintenance No fluctuation indicates possible lung expansion obstructed tubing improper suction
Avantae L. Cruz, RN, BSN Chest Tube Basics Assess for air leaks bubbling in water seal chamber indicates air leaks Monitor patients pain and treat accordingly Have patient cough & deep breathe q.2 hr Vitals q. 2-4 hrs
Avantae L. Cruz, RN, BSN Chest Tube Basics Observe and report immediately signs of rapid, shallow breathing, cyanosis, complaints of pressure in chest, or symptoms of hemorrhage ALWAYS keep 2 padded hemostats, sterile water and dressing supplies for possible disconnection
Avantae L. Cruz, RN, BSN Chest Tube Basics Notify MD for excessive drainage greater than 100ml/hr Change in drainage color Increasing chest pain
Avantae L. Cruz, RN, BSN Chest Tube Basics If a patient is to be transported place the drainage system below chest level DO NOT CLAMP THE CHEST TUBE DURING TRANSPORT clamping cause backflow of fluid into the pleural space
Avantae L. Cruz, RN, BSN Chest Tube Basics Completely change the drainage system when it nears full Set-up the new system exactly like the old Disconnect suction, disconnect the manufacturer’s connection, attach the new system and reconnect suction THIS IS THE ONLY APPROPIATE TIME TO BRIEFLY CLAMP THE TUBING
Avantae L. Cruz, RN, BSN Chest Tube Basics If a tube becomes disconnected clamp at the site of insertion using 2 padded hemostats Cut off the contaminated tip of the chest tube and tubing; insert a sterile connector into the chest tube and tubing and reattach the drainage system Cleanse tubing with chloroprep and allow to dry
Avantae L. Cruz, RN, BSN Chest Tube Basics If the chest tube accidentally slips or is pulled out IMMEDIATELY cover site with an occlusive dressing; this helps decrease the risk of a pneumothorax
Avantae L. Cruz, RN, BSN Chest Tube Documentation Patient and family education Vital signs Location of chest tube
Avantae L. Cruz, RN, BSN Chest Tube Documentation Insertion site and dressing Drainage Include color and amount Type of drainage system water seal vs. suction
Avantae L. Cruz, RN, BSN Chest Tubes Anytime you have a question please contact the patient’s MD or nursing supervisor
Avantae L. Cruz, RN, BSN Chest Tubes Please refer to POLICY #: NC-A 63.0