How to document chest tube assessment?

October 2, 2025 •

5 min read

Proper chest tube documentation is vital, as up to 20% of chest tube complications are related to improper management and monitoring. This guide outlines the authoritative, step-by-step process for a thorough chest tube assessment, ensuring every detail is recorded accurately to reflect patient status and system function.

Quick Summary

Accurate chest tube assessment documentation involves recording vital signs, respiratory status, insertion site appearance, and drainage system integrity, including drainage amount and characteristics. The record must also note the presence of tidaling, air leaks, and any patient pain to provide a complete clinical picture.

Key Points

Patient First: Always start your documentation by detailing the patient's respiratory status, vital signs, and pain level before assessing the chest tube system itself.
System Check: Document the integrity of the entire drainage system, ensuring the collection unit is upright, the tubing is patent, and all connections are secure.
Chamber Observations: Record specific findings from each chamber, including drainage output and characteristics, tidaling in the water seal, and bubbling patterns.
Insertion Site Details: Note the condition of the chest tube insertion site, dressing, and the presence or absence of subcutaneous emphysema (crepitus).
Full Clinical Picture: Combine observations of the patient and the drainage system to create a comprehensive picture of the patient's response to the chest tube, facilitating quick identification of complications.

The Importance of Precise Documentation

Accurate and timely documentation is not just a formality; it is a critical component of patient safety, communication among the healthcare team, and legal protection. For a chest tube assessment, the notes you leave provide a historical record of the patient's condition and response to therapy. A complete and meticulous record helps identify trends, spot complications early, and ensure continuity of care. It is a fundamental nursing responsibility that impacts patient outcomes directly.

Step 1: Patient Assessment

Before examining the chest tube system, a comprehensive assessment of the patient is paramount. This establishes a baseline and allows you to correlate changes in the patient’s condition with observations of the drainage system.

Focused Respiratory Assessment

Lung Sounds: Auscultate all lung fields, paying close attention to the affected side. Note the presence of any diminished or absent breath sounds. Document your findings clearly, for example, “breath sounds diminished in right lower lobe.”
Respiratory Effort: Observe the patient's work of breathing. Is it labored? Note the use of accessory muscles, respiratory rate, and oxygen saturation levels.
Symmetry: Note the symmetry of chest expansion during inspiration. Uneven expansion can be a sign of issues like a tension pneumothorax.

General Patient Status

Vital Signs: Record a full set of vital signs, including blood pressure, heart rate, and temperature. Note any significant changes from the patient's baseline.
Pain Level: Assess the patient’s pain level using a standardized scale (e.g., 0–10). Document their report of pain and the effectiveness of any pain medication given.
Subcutaneous Emphysema: Palpate the skin around the chest tube insertion site and the chest wall for crepitus. Crepitus feels like air trapped under the skin and indicates an air leak into the subcutaneous tissue. If present, document its location and extent.

Step 2: Drainage System and Tubing Assessment

The drainage system is a closed unit designed to remove air or fluid from the pleural space. A meticulous assessment of its components is essential for effective documentation.

Detailed System Check

System Integrity: Confirm that the entire system is intact, securely connected, and free from cracks or damage. The system must remain upright and below the level of the patient's chest at all times to prevent backflow of drainage.
Tubing Patency: Ensure the tubing is not kinked, looped, or clamped unnecessarily. Dependent loops can impede drainage and should be avoided.

Chamber-Specific Documentation

Collection Chamber: Mark the date, time, and fluid level on the exterior of the chamber to track drainage output accurately over time. Record the amount and characteristics of the drainage (color, consistency) on the patient's fluid balance chart. A sudden increase in output or a change to bright red drainage should be immediately reported.
Water Seal Chamber: Observe for tidaling, which is the fluctuation of the water level with respirations. Tidaling confirms a patent tube. Note if tidaling is absent, as this could mean the lung has re-expanded or the tube is blocked. Note any bubbling, its amount (e.g., intermittent or continuous), and if it increases with coughing. Continuous bubbling often indicates an air leak.
Suction Control Chamber: If suction is ordered, confirm it is set at the prescribed level and functioning correctly. For wet suction, observe for gentle, continuous bubbling. For dry suction, check the indicator bellows or float to ensure it's at the correct setting.

Step 3: Insertion Site and Dressing Assessment

The area where the chest tube enters the body requires close inspection to prevent complications like infection or tube dislodgement.

Insertion Site Inspection

Appearance: Assess the skin around the insertion site for signs of infection such as redness, swelling, or purulent drainage. Document the condition of the skin.
Tube Security: Confirm that the chest tube is properly secured to the chest wall with sutures or a securing device. Note if the tube is loose or appears to have moved since the last assessment.
Dressing: Check that the dressing is clean, dry, and intact. If a dressing change is required, document the procedure and the condition of the wound bed.

Comparison of Key Chest Tube Findings


Assessment Area	Normal Findings	Abnormal Findings
Drainage	Serous (light yellow), serosanguineous (pink), or sanginous (red) drainage that decreases over time.	Sudden large increase, change to bright red, or absence of expected drainage.
Water Seal	Tidaling (water level fluctuates with breathing). Intermittent bubbling on exhalation during air leak management.	Absent tidaling (lung re-expanded or obstruction). Continuous, vigorous bubbling (air leak).
Suction	Gentle, continuous bubbling in wet suction system. Bellows fully expanded in dry suction system.	No bubbling or vigorous bubbling in wet suction. Bellows not expanded in dry system.
Insertion Site	Clean, dry, and intact dressing. No redness, swelling, or crepitus.	Redness, swelling, purulent drainage. Subcutaneous emphysema (crepitus). Tube dislodgement.

Documenting Your Assessment: The Checklist Approach

To ensure all critical aspects are covered, use a systematic approach to documentation.

Record the date and time of your assessment.
Document a thorough respiratory assessment, including lung sounds, effort, and oxygen saturation.
Note vital signs and pain level.
Describe the appearance and output of the collection chamber, noting any changes.
Report findings from the water seal chamber regarding tidaling and bubbling.
If applicable, document the status of the suction control chamber.
Detail the condition of the chest tube insertion site and dressing.
Record any interventions performed, such as patient repositioning or pain medication administration.
Include patient teaching and their response to the assessment.

For further reference and in-depth nursing protocols, consulting authoritative sources like the National Institutes of Health (NIH) is highly recommended. This ensures you are following the latest evidence-based practices for chest tube care and documentation.

Conclusion

Thorough and accurate documentation of a chest tube assessment is a complex but essential nursing skill. By systematically assessing the patient's respiratory status, the drainage system's function, and the insertion site's integrity, healthcare professionals can ensure patient safety and promote optimal recovery. Adhering to a standardized documentation checklist provides a consistent, clear record for the entire care team, ultimately leading to better patient outcomes. Never underestimate the power of a well-documented assessment in managing a patient with a chest tube effectively.

Frequently Asked Questions

Tidaling is the fluctuation of the water level in the water seal chamber with the patient's breathing. Documenting its presence confirms the chest tube is patent. The absence of tidaling, especially after initial insertion, may indicate a blocked tube or that the patient's lung has re-expanded.

You should document any changes in the amount, color, or characteristics of the drainage. A sudden increase in volume, especially if it becomes bright red, should be immediately reported and documented as it could indicate a new bleed. Similarly, a sudden decrease could suggest a blockage.

If you observe bubbling in the water seal chamber that suggests an air leak, you must document its severity, and whether it is constant or intermittent. In systems with air leak meters, note the specific number. Also, document any interventions taken to locate the source of the leak, such as checking connections.

To document the insertion site, you must describe the condition of the dressing (clean, dry, intact), the skin around the site (no redness, swelling, or drainage), and confirm the tube's security. Palpate for crepitus and report its location and size if found.

The frequency of documentation is determined by institutional policy and the patient's condition. For a new chest tube, more frequent assessments (e.g., every 15 minutes for the first few hours) are common. After stabilization, it is typically done every 4 hours or at the beginning of every nursing shift.

Yes, documenting the patient’s pain level is crucial. Pain can affect respiratory effort and overall comfort. Recording a baseline and noting the effectiveness of pain management demonstrates a holistic approach to care and helps manage the patient's symptoms effectively.

Subcutaneous emphysema, or crepitus, is air trapped under the skin. It feels like crackling paper when palpated. You should document its presence, location (e.g., 'crepitus noted around chest tube site, extending to the shoulder'), and size. This indicates a worsening air leak.