1. Avantae L. Cruz, RN, BSN CHEST TUBES Do’s and Don'ts

2. 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

3. Avantae L. Cruz, RN, BSN Chest Tubes  Always keep below chest level  NEVER clamp  NEVER routinely milk MD should be notified and order obtained

4. 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

5. Avantae L. Cruz, RN, BSN Chest Tube Maintenance  No fluctuation indicates possible lung expansion obstructed tubing improper suction

6. 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

7. 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

8. Avantae L. Cruz, RN, BSN Chest Tube Basics  Notify MD for excessive drainage greater than 100ml/hr  Change in drainage color  Increasing chest pain

9. 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

10. 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

11. 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

12. 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

13. Avantae L. Cruz, RN, BSN Chest Tube Documentation  Patient and family education  Vital signs  Location of chest tube

14. 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

15. Avantae L. Cruz, RN, BSN Chest Tubes  Anytime you have a question please contact the patient’s MD or nursing supervisor

16. Avantae L. Cruz, RN, BSN Chest Tubes Please refer to POLICY #: NC-A 63.0