Chest Tube Insertion and Management

Chest tubes drain fluid, blood, or air from the pleural space, restore negative pressure, allow lung expansion, and correct intrapleural pressure.

Chest tubes can be placed in the emergency department, at the patient's bedside, or during surgery through a thoracotomy incision.

Chest tubes are removed when the lungs have fully expanded and there's no more drainage into the pleural space.

A common system has 3 chambers: drainage collection, a water seal, and suction control (wet or dry).

The water seal allows air to escape the pleural space during exhalation and prevents air from entering during inhalation.

Maintain the water seal chamber upright and below the insertion site; monitor and refill water as needed to maintain the correct level.

In wet suction, the fluid level in the suction control chamber determines the suction pressure delivered to the pleural space.

Movement of the water level in the water-seal chamber with each breath; indicates proper function.

A collapsed lung caused by air accumulating in the space between the lung and the chest wall (pleural space).

A collapsed lung caused by blood accumulating in the pleural space.

Fluid buildup in the pleural space causing lung compression.

Infection in the pleural space, causing pus accumulation and lung compression.

Difficulty breathing.

The water seal prevents air from entering the pleural space during inhalation.

The chest tube drainage system is placed below the chest level to promote drainage via gravity.

A chest tube helps to drain fluid, blood, or air from the pleural space and restore negative pressure in the chest cavity, allowing the lung to expand.

When a chest tube is inserted to remove air from the pleural space, the tip is placed near the apex of the lung.

When a chest tube is inserted to drain fluid from the lung, the tip is placed near the base of the lung.

The chest tube is inserted into the pleural space to remove fluid, blood, or air and restore negative pressure, allowing the lung to expand.

Keep the drainage system below the client's chest level to promote drainage by gravity.

Clamping the chest tube is only done in specific circumstances, like during drainage system changes or accidental disconnection, as it can cause a tension pneumothorax.

Monitor for excessive drainage (greater than 70 mL/hr), cloudy or red drainage, and report immediately to the provider.

Monitor the chest tube insertion site for redness, pain, infection, and crepitus (air leakage) to detect complications early.

Air escaping from the pleural space through a loose connection or a hole in the chest tube system.

A sudden separation of the chest tube from the drainage system.

If a chest tube is accidentally removed, immediately cover the site with dry, sterile gauze.

Instruct the client to exhale deeply and cough to remove air from the pleural space.

If the chest tube drainage system is compromised, immerse the end of the chest tube in sterile water to create a temporary water seal.

A tension pneumothorax can be caused by things like a sucking chest wound, prolonged clamping of the tubing, kinks or obstructions in the tubing, or mechanical ventilation with high levels of PEEP.

Signs of a tension pneumothorax include tracheal deviation, absent breath sounds on one side, distended neck veins, respiratory distress, asymmetry of the chest, and cyanosis.

Before removing chest tubes, provide pain medication. Assist the provider with sutures and chest tube removal. During removal, instruct the client to perform a Valsalva maneuver (exhale and bear down) or hold their breath. Apply an airtight sterile petroleum jelly gauze dressing and secure it with stretch tape.

The Valsalva maneuver is performed to increase intrathoracic pressure and reduce the risk of air emboli during chest tube removal.

After chest tube removal, obtain chest x-rays as prescribed, monitor for excessive wound drainage, signs of infection, and recurrent pneumothorax.