When it comes to managing a patient’s care, chest tubes play an essential role in helping physicians assess and treat conditions involving the lungs. As nurses, we must understand how to manage these tubes effectively and safely to ensure our patients receive healthy and adequate care.
In this blog post, we’ll explore different nursing management of chest tubes, chest tube output
as well as potential complications associated with their use so that you can have the confidence you need when caring for your patients.
Table of Contents
What is Chest Tube?
If you’ve ever watched a medical drama, you may have seen a chest tube inserted into a patient’s chest in a theatrical moment. But what exactly is a chest tube, and why would someone need one? A chest tube is a thin, flexible tube inserted into the pleural cavity (the space between the lungs and the chest wall) to drain out air or fluids that have built up there.
This could be due to various causes, such as a collapsed lung, a buildup of blood following trauma, or a collection of fluids caused by infection or other conditions. Chest tubes can be lifesaving in critical situations but can also be uncomfortable and pose certain risks. Understanding what they are and how they work can help you feel more informed and empowered if you or a loved one ever needs one.
Components & Types of Chest Drain Systems
Types
Chest tubes come in various shapes and sizes, with different components that make them function properly. Generally, they comprise an internal tube (or catheter) inserted into the pleural cavity, a drainage unit for collecting fluids or air, and a seal to secure it.
The most common type of chest tube system is the Heimlich valve, which uses an adjustable one-way valve that allows air and fluid to be drained but not enter back into the cavity. Other systems may use gravity-dependent drainage, suction, or an electronic control unit.
Components
Collection chamber
The chest tube connects directly to the collection chamber, which collects drainage from the pleural cavity. The chamber is calibrated to measure the drainage. The outer surface of the chamber has a “write-on” surface to document the date, time, and amount of fluid. This chamber is typically on the far right side of the system.
Water-seal chamber
The water-seal chamber is a small chamber filled with sterile water that creates a seal between the collection chamber and the patient. This prevents air from entering into the pleural cavity. The water-seal chamber must be filled with sterile water and kept at the 2 cm mark for optimal functioning. The level should be checked regularly and topped up as needed.
Chest tube Tidaling
When breathing, the water in the chamber should rise during inhalation and fall on exhalation, a process referred to as ‘tidaling’. Continuous bubbling could signal an air leak; modern systems include a measurement system for such leaks – the higher the number, the bigger the leak. Additionally, the chamber can also measure intrathoracic pressure.
Wet or dry suction control chamber:
The wet or dry suction control chamber is a small, pressurized glass bottle that can be used to either provide intermittent suction (dry) or constant suction (wet). The pressure in this chamber should always remain above atmospheric pressure. This is so the chamber does not collapse when negative intrathoracic pressure occurs during inspiration.
Medical Uses
A chest tube is used in a variety of situations but mainly falls into a few categories:
- Pneumothorax: To remove air or fluid from a collapsed lung, or pneumothorax.
- Hemothorax: To remove the blood and other fluids in cases of trauma or surgery.
- Pleural effusion: To drain a pleural effusion which is the buildup of fluid between the lungs and chest wall caused by infection, tumors, heart failure, chemotherapy, kidney disease, or other conditions.
- Pneumothorax: To drain a hemothorax, which is the buildup of blood between the lungs and chest wall from trauma or surgery.
Procedure
A doctor may administer general anesthesia to a person to facilitate the chest tube insertion. Alternatively, they can utilize a local anesthetic to numb the affected area before inserting the tube and provide sedatives and pain medications.
There are various incision approaches for inserting the chest tube, but the strategy will follow the same essential steps:
- Elevating the head of a person’s bed by 30–60 degrees.
- Making a small incision in the person’s chest wall, usually near the rib.
- Insert the tube through the incision and into the pleural cavity.
- Positioning the end of the tube to ensure optimal drainage.
- Securing the tube with sutures or sterile tape.
- Connecting the tube to a suction or drainage system.
- Monitoring the tube to ensure optimal functioning and drain placement.
Normal Chest Tube Drainage Per Hour:
When it comes to post-surgical recovery or treating traumatic injuries, a chest tube is often inserted to drain fluids and air from around the lungs. But how much drainage is considered normal?
Generally, normal chest tube drainage per hour is up to 100– 200 milliliters of fluid. However, it’s entirely up to the patient and their overall health.
Some patients may only experience 30 milliliters per hour, while others may have up to 300 milliliters. It’s essential to monitor the amount of drainage to ensure proper healing but don’t be alarmed if your drainage levels vary from others. Always consult your doctor for concerns or questions about your chest tube drainage.
Complications
When performing a chest tube insertion, the physician must take special care to navigate around several major organs in the thoracic cavity, such as the lungs and heart. This procedure requires precision and skill for successful completion.
Potential complications include:
- Injury to nearby organs, such as the lungs and other parts of the chest wall.
- Air or fluid leakage from the incision site.
- Excessive bleeding from the incision site.
- Infection at the insertion site.
- Pain or discomfort in the area around the tube insertion.
- Swelling, redness, and warmth at the incision site.
What is the nurse’s responsibility when managing a patient’s chest tube?
If your patient has a chest tube, you must always ensure it functions properly. Sounds simple enough, right? Here are some basics you’ll want to implement with every single chest tube patient, every single time:
How Can Nurses Manage a Chest Tube?
As a healthcare provider, it is essential to monitor your patient’s chest tube’s functioning constantly. Sounds simple enough, right? Here are some basics you’ll want to implement with every single chest tube patient, every single time:
- Have your safety equipment ready.
- Monitor the chest tube site for signs of infection every 30 minutes. Look for tenderness, redness, or swelling.
- Maintain a sterile field while changing the dressing and connecting/disconnecting equipment to/from the chest tube. Change dressings as often as needed, depending on how much drainage is present.
- Connect the tubing securely so that it won’t be pulled out accidentally (if your patient moves around). Make sure all connections are tight and secure before leaving your patient unattended.
- Check the water seal chamber at least every hour; adjust suction levels if necessary. When suction is applied, the water column should remain steady with no bubbling or changes in Level.
- Monitor for any air leaks in the system, especially when assessing it after disconnecting or connecting different pieces of equipment.
- Verify that drainage is present in the collection chamber and tubing every hour. The amount should be consistent with the patient’s output over time.
- Document all parameters (suction levels, amount of drainage, etc.) in the patient’s chart.
- If your patient is on continuous suction, attach a new collection chamber every 24 hours and document its placement and date/time of change in the patient’s chart.
- Monitor the patient for any signs or symptoms of chest tube complication (e.g., air or fluid in the pleural space).
- Follow your institution’s protocol for chest tube removal.
- Educate your patient on how to care for themselves post-chest tube removal.
- Dispose of used equipment properly (including collection chambers).
- Be prepared to take action if any complications arise.
- Know when the chest tube should be removed and how to go about it safely.
How To Manage Air Leaks?
When managing a chest tube, being aware of air leaks is essential. Air can enter the pleural cavity if the seal between the chest tube and the collection chamber is not tight enough.
This can lead to tension pneumothorax, a medical emergency requiring immediate intervention.
Nurses need to monitor for signs of air leaks with every chest tube patient. Signs of air leak can include:
- Continuous bubbling in the collection chamber
- Increase in fluid output
- Inability to maintain a water seal or decrease in suction pressure
If you suspect an air leak, notify your healthcare provider immediately. Additional interventions, such as adjusting the chest tube placement or increasing suction, may be needed. Ensuring that the chest tube system is inspected regularly for leaks or other damage is also essential.
It is also essential to monitor intrathoracic pressure with a device such as an intrapleural manometer if available. This can help determine if any changes in pressure might indicate an air leak. If there are, the device should be adjusted accordingly.
Finally, it is essential to document any changes in the chest tube system and patient status as they occur. This will help keep track of any issues that may arise with the chest tube and provide a written record of care for future reference.
What if the leak is coming from the patient?
If a leak is coming from the patient, it can indicate an underlying problem that needs to be addressed. In this case, further assessment and interventions may need to be done to determine the cause of the air leak. Possible causes could include:
- Incorrect tube placement or tube malpositioning
- Tubing kinks or blockages in the chest tube system
- Disconnection of tubing or improper connections
- Intrapleural trauma caused by the tube insertion itself
- Considering these potential causes and evaluating any underlying problems that must be addressed is essential.
If there are any issues, your healthcare provider will provide further instructions. Another chest tube insertion may sometimes be necessary to re-establish proper airflow and drainage.
Frequently Asked Questions About Chest Tube-Related Problems
What is the most common indication for a chest tube?
The most common indication for chest tube insertion is pleural effusion, fluid accumulation in the pleural space. This can occur due to various causes, including congestive heart failure, liver cirrhosis, or infections such as pneumonia. Other indications include pneumothorax (collapsed lung), hemothorax (accumulation of blood in the pleural space), and air leaks.
How do you confirm chest tube placement?
Confirmation of chest tube placement is typically done by visualization of condensation within the tube with respiration or by drained pleural fluid seen within the tube. Ask the patient to cough, and observe whether bubbles form at the water-seal level. If the tube has not been correctly inserted in the pleural space, no fluid will drain, and the level in the water column will not vary with respiration.
How many holes are in a chest tube?
It depends on the type of chest tube. A simple single-lumen chest tube typically has one hole, while a multi-lumen (double-barreled) chest tube may have two or more holes. The number of holes will depend on the purpose of the chest tube. For example, a double-barreled chest tube often drains air and fluid from the pleural space.
What if the chest tube becomes dislodged?
If a chest tube becomes dislodged, you must notify your healthcare provider and take the appropriate steps to re-secure the tube. Depending on the type of chest tube, this may involve replacing the subcutaneous sutures or taping it back in place. It is also essential to check for any signs of air or fluid leaks around the insertion site. Further consultation with a healthcare provider may be necessary if an air leak is present.
What if there’s a clot in my tubing?
If a clot is present in the tubing, you must notify your healthcare provider and take any necessary steps to remove or dissolve the clot. Depending on the type of chest tube, this may involve flushing the tubing with a saline solution or using an anticoagulant to dissolve the clot. If the chunk is large or difficult to remove, you may need to replace the tubing. Your healthcare provider will be able to provide further guidance on the appropriate action to take.
What if the red drainage abruptly increases?
This could point to a hemorrhage. Immediately contact your MD STAT and be ready for surgery.
What if there is a sudden lack of drainage?
This could signal a blockage or kink in the tubing. Carefully check over all tubing, removing clogs or kinks as your institution allows. If the patient’s condition quickly worsens, inform the MD STAT – they may decide to “milk” the tubing. You can do this.
What if your patient deteriorates quickly?
This could be a sign of tension pneumothorax. Again, check the tubing for any blockages or kinks and immediately alert the MD STAT. You got this.
What if the chest tube becomes disconnected?
In such cases, it is crucial to take immediate action. Patients may experience sudden shortness of breath, chest pain, or difficulty breathing. It is essential to remain calm and avoid touching the disconnected tube. Notify a medical professional right away to reconnect the tube safely. Proper care and attention during such moments can prevent complications and ensure a safe recovery for the patient.
How long will the chest tube remain in place?
The answer will depend on various factors, including the reason for the chest tube and how quickly the patient’s condition improves. Patients may be required to keep the chest tube for only a few days, while others may need to wear it for several weeks. Regardless of the time, patients must follow their doctor’s orders and take necessary precautions to ensure they are comfortable and healing properly.
References
- https://medlineplus.gov/ency/article/002947.htm
- https://www.ncbi.nlm.nih.gov/books/NBK459199/
- https://en.wikipedia.org/wiki/Chest_tube
Mrs. Marie Brown has been a registered nurse for over 25 years. She began her nursing career at a Level I Trauma Center in downtown Chicago, Illinois. There she worked in the Emergency Department and on the Surgical Intensive Care Unit. After several years, she moved to the Midwest and continued her nursing career in a critical care setting. For the last 10 years of her nursing career, Mrs. Brown worked as a flight nurse with an air ambulance service. During this time, she cared for patients throughout the United States.