Equipment
■ 2 disposable chest drainage units (CDU).
■ Chest tube insertion kit (common tube size for adults is 36 Fr; kit should contain povidone-iodine, local anesthetic, syringe, needles, drapes, scalpel, suture).
■ 5-in-1 or Y-connector for two chest tubes, if not contained in insertion kit.
■ 2 rubber-tipped hemostats.
■ Sterile gloves, masks, and sterile gowns.
■ Sterile 4 in. 4 in. gauze dressings.
■ Sterile, precut drain dressings.
■ Petroleum-based gauze dressings.
■ Large drainage dressings (e.g., ABD).
■ 2-in. silk tape.
■ 1-in. silk tape or nylon banding system for securing tube connections.
■ For a water-seal system, you also need sterile water.
Assessment
■ Ensure that the patient has venous access.
■ Assess:
■ VS.
■ Level of consciousness, orientation, responsiveness, anxiety, and restlessness.
■ Patient’s knowledge of chest tube therapy.
■ Cardiac and respiratory status, including rate, depth, and rhythm.
■ Breath sounds.
■ Skin color.
■ Pulse oximetry.
■ ABG results.
Post-Procedure Reassessment
■ Evaluate the patient’s tolerance to the chest tube insertion.
■ Determine whether the patient’s respiratory status has changed after tube insertion.
■ Auscultate breath sounds every 2 hours.
■ Check type, color, and amount of chest drainage every 15 minutes for the first 2 hours, and then check as prescribed (at least every 4 hours).
■ Assess for crepitus and drainage around the chest tube insertion site.
■ Check the disposable chest drainage system for air leaks.
■ Monitor I&O every 8 hours.
■ Check laboratory values to evaluate blood loss and oxygenation.
Key Points
■ Obtain and prepare the prescribed drainage system.
■ Position the patient according to the indicated insertion site.
■ Open the chest tube insertion tray and set up the sterile field.
■ Don mask, gown, and sterile gloves and organize the supplies you will need for dressing the insertion site.
■ As soon as the chest tube is inserted, attach it to the drainage system.
■ Turn on the wall (or other) suction source (usually –80 mm H2O).
■ Set the prescribed CDU suction level (usually –20 cm H2O).
■ After the clinician sutures the chest tube in place, don a clean pair of sterile gloves.
■ Be Safe! Using sterile technique, wrap petroleum gauze around the chest tube at the insertion site, and dress the site with two precut sterile drain dressings covered by a large drainage dressing (e.g., ABD).
■ Be Safe! Apply an occlusive dressing over the insertion site (e.g., with 2-inch silk tape); cover the dressing completely. Date, time, and initial the dressing.
■ Be Safe! Using the spiral taping technique, wrap 1-inch silk tape around the connections. Wrap from top to bottom and bottom to top. (Or use locking connections, if furnished with the CDU).
■ With an 8-inch-long piece of 2-inch tape, secure the top end of the drainage tube to the chest tube dressing.
■ Make sure the tubing lies with no kinks and no dependent areas, in a straight line to the CDU.
■ Prepare the patient for a portable chest x-ray exam.
■ Be Safe! Keep emergency supplies at the bedside in the event of tube dislodgement or system failure (2 rubber-tipped clamps, petroleum gauze dressing, and spare disposable CDU).
■ Be Safe! Maintain the chest tube and drainage system by preventing kinks, ensuring patency of the air vent, and keeping the system below the level of the chest tube.
■ Be Safe! Keep the head of the bed always elevated to at least 30°.
Documentation
■ Document:
■ Assessment findings before, during, and after chest tube insertion (e.g., VS, breath sounds, cardiac status, pulse oximetry).
■ Date and time of the chest tube insertion.
■ Name of the clinician who performed the procedure.
■ Location of the insertion site, size of the chest tube, type of drainage system, and amount of suction applied, if any.
■ Any medications the patient received during the procedure.
■ Color and amount of drainage.
■ Patient’s tolerance to the procedure.
■ Presence of subcutaneous emphysema or air leak, if any.
■ Complications and any interventions preformed as a result of the complications.
■ Chest x-ray findings.
■ Record chest tube output on the I&O portion of the flowsheet (in most agencies).
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| CDU set up and in place |
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| Precut drain dressing |
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| Spiral taping the connector |
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