Chest Tubes: Placement and Function

• Chest tubes are thin tubes inserted into the pleural cavity.
• Pleural cavity: Space between visceral and parietal pleura.
• Chest tubes are also known as pleural catheters.
• Chest tube restores lung function by removing excess fluid or air.
• Chest tubes are used to instill chemotherapeutic drugs or sclerosing agents to treat recurrent pleural effusions (pleurodesis).
• Chest tubes can be used prophylactically after thoracic or cardiac surgery to prevent fluid accumulation.
• Chest tubes are placed either percutaneously or surgically.

Placement

• For pneumothorax, the tube is directed high and anterior.
• For hemothorax, the tube is directed posteriorly and lateral to the nipple line.
• The Chest tube is sutured in place.
• The insertion site is covered with an occlusive petroleum gauze dressing.
• It is attached to a chest drainage unit (CDU).

Chest Drainage Unit (CDU)

• CDUs restore normal intrapleural pressure.
• CDUs facilitate drainage of air and fluid.
• CDUs prevent backflow of air.
• CDUs are categorized by the number of chambers and mechanisms preventing air entry.
• Three-chamber systems are widely used.

CDU Chambers

• Collection chamber: Collects drained fluids, allowing monitoring of characteristics and quantity.
• Water-seal chamber: Acts as a one-way valve, allowing drainage of air and fluid, and preventing air entry.
  • The chamber is filled with sterile water.
  • Water oscillates with breathing (tidaling), reflecting normal pressure.
• Suction control chamber: Regulates the amount of negative pressure generated.
  • "Wet Systems": Suction pressure is regulated by water column height.
  • "Dry Systems": Use a regulator and suction monitor bellows.
  • Suction pressure is commonly set at negative 20 cm of water.

Nursing Interventions

• Ongoing assessments are needed, and nurses need core clinical knowledge
• Follow facility policies including CDU recommendations
• Practice hand hygiene and aseptic technique.
• Report new or significant changes in patient condition.

Nursing Interventions - Monitoring

• Frequency per facility policy:
• Vital signs.
• Respiratory status: skin color, respiratory depth/rhythm, accessory muscle use, O2 saturation, breath sounds.
• Pain level.
• Insertion site dressing: dry, intact, occlusive, subcutaneous emphysema signs.
• Drainage and suction tubing: kinks, bends, dependent loops, loose connections, air leaks, patency.
• Wall suction: generally set at 80-120 mmHg.
• Correct CDU positioning.
• Presence of emergency equipment.

Nursing Interventions - Ongoing Care

• Change insertion site dressing:
  • Per physician’s orders.
  • Assess insertion site: infection, displaced tube, subcutaneous emphysema.
• Change CDU when full or not functioning.
• Educate the patient on frequent position changes, coughing, and deep breathing.