Providing Care of a Chest Drainage System

Goal: The patient does not experience any complications related to the chest drainage system or respiratory distress.

1. Bring necessary equipment to the bedside stand or overbed table.

2. Perform hand hygiene and put on PPE, if indicated.

3. Identify the patient.

4. Close curtains around bed and close the door to the room, if possible.

5. Explain what you are going to do and the reason for doing it to the patient.

6. Assess the patient’s level of pain. Administer prescribed medication, as needed.

7. Put on clean gloves.

Assessing the Drainage System
8. Move the patient’s gown to expose the chest tube insertion site. Keep the patient covered as much as possible, using a bath blanket to drape the patient, if necessary. Observe the dressing around the chest tube insertion site and ensure that it is dry, intact, and occlusive.

9. Check that all connections are securely taped. Gently palpate around the insertion site, feeling for subcutaneous emphysema, a collection of air or gas under the skin. This may feel crunchy or spongy, or like “popping” under your fingers.

10. Check drainage tubing to ensure that there are no dependent loops or kinks. Position the drainage collection device below the tube insertion site.

11. If the chest tube is ordered to be suctioned, note the fluid level in the suction chamber and check it with the amount of ordered suction. Look for bubbling in the suction chamber. Temporarily disconnect the suction to check the level of water in the chamber. Add sterile water or saline, if necessary, to maintain correct amount of suction.

12. Observe the water-seal chamber for fluctuations of the water level with the patient’s inspiration and expiration (tidaling). If suction is used, temporarily disconnect the suction to observe for fluctuation. Assess for the presence of bubbling in the water-seal chamber. Add water, if necessary, to maintain the level at the 2-cm mark, or the mark recommended by the manufacturer.

13. Assess the amount and type of fluid drainage. Measure drainage output at the end of each shift by marking the level on the container or placing a small piece of tape at the drainage level to indicate date and time. The amount should be a running total, because the drainage system is never emptied. If the drainage system fills, it is removed and replaced.

14. Remove gloves. Assist patient to a comfortable position. Raise the bed rail and place the bed in the lowest position, as necessary.

15. Remove additional PPE, if used. Perform hand hygiene.

Changing the Drainage System
16. Obtain two padded Kelly clamps, a new drainage system, and a bottle of sterile water. Add water to the water-seal chamber in the new system until it reaches the 2-cm mark or the mark recommended by the manufacturer. Follow manufacturer’s directions to add water to suction system if suction is ordered.

17. Put on clean gloves and additional PPE, as indicated.

18. Apply Kelly clamps 1.5 to 2.5 inches from insertion site and 1 inch apart, going in opposite directions.

19. Remove the suction from the current drainage system. Unroll or use scissors to carefully cut away any foam tape on the connection of the chest tube and drainage system. Using a slight twisting motion, remove the drainage system. Do not pull on the chest tube.

20. Keeping the end of the chest tube sterile, insert the end of the new drainage system into the chest tube. Remove Kelly clamps. Reconnect suction, if ordered. Apply plastic bands or foam tape to chest tube/drainage system connection site.

21. Assess the patient and the drainage system as outlined (Steps 5–15).

22. Remove additional PPE, if used. Perform hand hygiene.