Comprehensive Guide to Chest Tubes

Mar 29, 2025

NCLEX Review: Chest Tubes

Purpose of a Chest Tube

  • Definition: A tube inserted into the pleural space of the lungs to remove air or fluid, aiding lung re-expansion.
  • Anatomy:
    • Visceral Pleura: Protective layer around the lung.
    • Parietal Pleura: Attaches to the thoracic cavity.
    • Pleural Space: Contains serous fluid allowing the pleurae to glide over each other.
  • Function:
    • Maintains negative pressure allowing proper lung inflation and deflation.
    • Removes air/fluid causing lung collapse.

Types of Chest Tubes

  • Pleural Chest Tube: Addresses pneumothorax or pleural effusion.
  • Mediastinal Chest Tube: Inserted post-cardiac surgery to remove blood/fluid around the heart.

Indications for Chest Tube Placement

  • Pneumothorax: Air enters the pleural space causing lung collapse.
  • Pleural Effusion: Fluid accumulation in the pleural space.
    • Types of Effusions:
      • Hemothorax: Blood enters pleural space due to trauma or disease.
      • Empyema: Infection in pleural space.
      • Chylothorax: Lymphatic fluid enters pleural space.
  • Post-cardiac Surgery: Drains fluid/blood to prevent cardiac tamponade.

Chest Tube Drainage Systems

  • Basic Setup:
    • Drainage Chamber: Collects fluid from lungs.
    • Water Seal Chamber: Prevents air from entering while allowing air removal.
    • Suction Control Chamber: Regulates suction pressure.
  • Types of Systems:
    • Wet Suction:
      • Regulated by water height in the suction control chamber.
      • Connected to wall suction, may see gentle bubbling.
    • Dry Suction:
      • Uses a suction monitor bellow, no water column.
      • Adjustable wall suction with a rotary dial.
      • Advantages: Higher suction options, no water evaporation.

Nursing Interventions

  • Monitor Patient's Respiratory Status: Check lung sounds and breathing.
  • Maintain Drainage System:
    • Keep system below chest level.
    • Secure tubing, avoid kinks, ensure proper drainage.
  • Water Seal Chamber:
    • Check for oscillation/fluctuation (normal).
    • No fluctuation may indicate re-expanded lung or a kink.
    • Monitor for bubbling (air leak indication).
  • Responding to Complications:
    • If dislodged, cover with sterile dressing taped on three sides.
    • If system breaks, place tubing in sterile water.

Removal of Chest Tube

  • Assist physician during removal:
    • Gather supplies (sterile gloves, dressing, suture kit).
    • Teach and practice Valsalva maneuver with patient.
    • Monitor post-removal respiratory status.
    • Expect a post-removal chest X-ray to check lung expansion.

Additional Considerations

  • Avoid Milking/Stripping Tubing: Not recommended due to increased pressure risks.
  • Clamping: Only with physician's order, follows specific protocols.

Resources

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