Overview
This lecture covers key facts about chest tubes, their chamber system, indications, care, and actions for complications, as needed for the NCLEX exam.
Chest Tube Purpose and Indications
- Chest tubes remove air or fluid from the pleural cavity by creating a vacuum.
- Air in the pleural space is called a pneumothorax.
- Blood in the pleural space is called a hemothorax.
Chest Tube Chamber System
- All chest tubes use a three-chamber (Three Bottle) system.
Collection Chamber
- Collects drainage from the pleural space.
- Expected drainage color: serosanguinous (a mix of serum and blood).
- Check and measure drainage every 4 hours.
- Drainage should not be bright red (may indicate hemorrhage).
- Drainage should not exceed 100 mL per hour (may indicate hemorrhage).
Water Seal Chamber
- Contains about 2 cm of water; acts as a one-way valve.
- Should see gentle tidaling (movement) with breathing.
- Continuous bubbling indicates an air leak and is abnormal.
Suction Control Chamber
- Applies suction to the system and also contains water.
- Bubbling should be present here, indicating suction is functioning.
- Absence of bubbling means suction is not working properly.
Chest Tube Care and Safety
- Keep the chest tube system below chest level at all times.
- Never place the system on the bed or hang it from an IV pole.
- Encourage coughing, deep breathing, and repositioning every hour to promote drainage.
- Never milk (strip) the chest tube, as this may cause a pneumothorax.
- If the chest tube is accidentally pulled out, cover the site immediately with a gloved hand, then apply an occlusive dressing.
- Do not attempt to reinsert a chest tube yourself.
Key Terms & Definitions
- Pneumothorax — presence of air in the pleural space.
- Hemothorax — presence of blood in the pleural space.
- Serosanguinous — drainage that is pinkish, containing both serum and blood.
- Tidaling — gentle rise and fall of water in the chamber with breathing.
- Occlusive dressing — airtight dressing used to cover an open chest wound.
Action Items / Next Steps
- Familiarize yourself with chest tube chambers and care procedures.
- Look up the color "serosanguinous" if unfamiliar.
- Practice identifying chest tube complications for NCLEX preparation.