Maintaining Chest Tubes
Managing a Patient with a Chest Tube
Normal chest x-ray
Hemothorax left lower lobe.
Tension pneumothorax: air rises so that the chest tube would be inserted higher on the chest wall. A tension pneumothorax is an emergency situation since a mediastinal shift twists the heart and great vessels. The pressure on one side of the chest is pushing the mediastinum over to the other side. An assessment measure is to check the trachea for midline position. Note that the chest tube would need to be inserted low on the chest wall.
Assessing the Patient with a Chest Tube
- Signs of respiratory distress, deviated trachea, etc.?
- Dressing: intact? crepitus? [An occlusive dressing is generally used to prevent air entering the pleural space.]
- Tubing: kinks? dependent loops? connections taped? clots present?
- Drainage system: intact?
- Collection Chamber: expected amount and type of drainage?
- Water-seal Chamber: correct water level? bubbling? [Bubbling indicates an air leak is present]
- Suction Control Chamber: suction set to ordered amount of suction?
Very often, potential problems can usually be avoided by routinely checking the patient, tube connectors, and drainage system at regularly scheduled intervals. Listed below are many of those common problems that can be easily corrected:
- clot in chest tube inside patient
- clot in the patient tube
- dependent loop in patient tube with fluid
- kink in patient tube from bed rail or patient position
- partial dislodgement of catheter from patient
- partial disconnection of patient tube from chest tube connector
- overfilled water seal (water is above 2cm line)
- in-line connectors not properly secured
- patient tube clamp may be closed
- floor stand is not fully opened
- chest drain is not upright
- chest drain is not positioned sufficiently below patient's chest
- suction monitor bellows does not fully expand because source suction falls below the minimum operating range or poor connection
- Suction control is bubbling too vigorously
from "Managing Chest Drainage" booklet published by Atrium Medical Corporation