What are the priority nursing interventions for the management of a patient with a chest tube?

As nurses develop nursing skills in the nursing profession, they must learn the proper manner in which to care for chest tubes and how to change the chest tube dressing of their patients. Patients depend on the experience of nurses to ensure that their medical care is as precise as possible.

What is a Chest Tube?

A chest tube goes by many different names, including chest drainage tube and chest drain. The plastic tube enters the side of the patient’s chest to remove blood, air, or fluid from around the heart and lungs.

The lung contains two tissue layers called pleura that contain fluid that assists the lungs with helping patients breathe. Conditions and diseases—such as pleural effusion, emphysema, tumors, heart failure, hemothorax, infection, and pneumothorax—may cause blood, air, or additional fluid to gather in the pleural space.

The chest tube helps the patient breath better by expanding the lungs. Without the use of a chest tube, patients who have certain conditions and diseases may have their lungs collapse if the pressure becomes too great in their chest.

How to Care for Chest Tubes

• Nurses have the responsibility to care for their patients’ chest tubes after they have been properly inserted so that the pleural drainage system remains clear and intact. The following are steps to care for chest tubes.
• Wash hands thoroughly with soap and warm water and don sterile gloves before coming in contact with the patient.
• The chest tube should contain approximately 6 feet of tubing that connects to a collection device located several feet below the patient’s chest. Instruct the patient not to rest the body on the tubing. The nurse should take this time to check the patient’s tubing for twists and kinks in the tubing line. The nurse should also tape the tubing connections to prevent air from leaking out of the tube.
• The drainage system has a water seal that operates as a one-way valve. The nurse must add the required amount of saline into the patient’s separate water chamber while ensuring the end of the patient’s tubing remains in the fluid.
• Add suctioning to the chest drainage system if necessary, but remember that the amount of suctioning depends of the saline solution’s depth.
• The nurse should make a note of the level of drainage at the end of his or her shift. Also, document the color and amount of the drainage in the patient’s notes.
• The respiratory status of the patient requires frequent assessment to maintain the patient’s health. Nurses should also make note of decreased breathing sounds near the side of the patient’s chest tube.
• To maintain the care of the chest tube, nurses should encourage the patient to perform deep-breathing exercises or coughing.

Video on Chest Tube Care

Steps on How to Change a Chest Tube Dressing

1. Gather the necessary materials, which include sterile gloves, drain sponges, tape (2 to 4 inches), 4×4” gauze sponges, ChloraPrep, and 5X9” Xeroform gauze.
2. Wash the hands with soap and warm water and put on a pair of sterile gloves.
3. Remove the patient’s old dressing and insect the site of the chest tube for bleeding, redness, air leaks, skin discoloration, condition of sutures, and color and amount of drainage.
4. Remove the old gloves and don a new pair of sterile gloves. Clean the site with ChloraPrep. Use an antiseptic to clean the first two inches of the patient’s chest tube, beginning where the tube exits the skin. Repeat this process twice and allow the area to dry.
5. Use Xeroform to create an air-tight seal at the insertion site of the chest tube for patients receiving trauma services.
6. Split the 4×4 dressing and place it around the patient’s chest tube. Make sure that the opening slits do not overlap. Apply two additional 4×4 sponges over the previous layer of dressing that covers the chest tube.
7. Apply tape over the dressing. Make note of the time and date the dressing was changed.
8. Remove and dispose of the gloves and wash hands thoroughly.

Complications with Chest Tubes

The complications that patients may experience as a result of the chest tube include infection and blood clots in the arm or leg. The blood clots can travel to the patient’s lungs, causing breathing problems and chest pain, which can be life-threatening. The tube can also poke through organs close to the lungs. The chest tube can also move out of place as the patient turns or moves.

Nurses have a great responsibility when it comes to caring for their patients. The patient’s chest tube must receive proper care so that infections and life-threatening conditions do not occur. With practice, nurses will learn to care for chest tubes with ease.