The Foundational Role of Nursing in Chest Drainage
A nurse's responsibilities for a patient with chest drainage are extensive and critical to ensuring optimal recovery and preventing serious complications. These duties begin the moment a new chest tube is inserted and continue until it is safely removed. A nurse must possess a deep understanding of the equipment, patient physiology, and potential complications.
Initial Patient Assessment and Bedside Preparation
Upon a patient's arrival with a new chest tube, the nurse performs crucial initial actions to establish a baseline and prepare the environment for safe care.
- Verify Orders: The nurse first confirms the healthcare provider's orders regarding the chest tube, including the level of suction required and any special instructions.
- Baseline Vitals: An initial set of vital signs, including oxygen saturation, and a focused respiratory assessment are documented. This provides a baseline to monitor for changes, such as increased respiratory rate or decreased oxygenation, which could signal a complication.
- Pain Assessment: A baseline pain level is assessed, particularly around the insertion site, to guide initial pain management strategies.
- Prepare Emergency Supplies: According to agency policy, essential equipment is gathered and placed at the bedside. This includes rubber-tipped clamps, sterile 4x4 gauze, petroleum gauze, tape, and a container of sterile water.
Continuous Monitoring of the Drainage System
Throughout the patient's stay, the nurse must vigilantly monitor the chest drainage system to ensure its integrity and proper function.
- Positioning and Tubing Integrity: The system must be kept upright and below the level of the patient's chest at all times to prevent backflow. The tubing is regularly checked for kinks, dependent loops, or clots that could obstruct drainage.
- Fluid Assessment: The nurse assesses and documents the amount, color, and characteristics of the drainage in the collection chamber. For ongoing tracking, the drainage level is marked on the container with the date and time each shift. A change from bloody to serosanguinous to serous drainage is expected over time.
- Water Seal Chamber: Tidaling, the normal rise and fall of fluid with respiration, is assessed. The absence of tidaling could indicate the lung has re-expanded or a blockage exists. Continuous bubbling in the water seal, however, is a sign of a persistent air leak that must be investigated.
- Suction Control Chamber: For wet suction systems, the nurse confirms that the water level is correct and that gentle, constant bubbling is present. For dry suction systems, the nurse verifies the dial is set to the prescribed suction level and that the indicator, such as a bellows or float, is visible.
Patient Care and Mobility
Active nursing care extends beyond the drainage system to include the patient's overall well-being and recovery.
- Respiratory Support: The nurse encourages and assists the patient with deep breathing exercises, coughing, and using an incentive spirometer to promote lung expansion.
- Pain Management: Pain is a common issue with chest tubes. The nurse administers prescribed pain medication and utilizes non-pharmacological interventions, such as repositioning and splinting the site, to manage discomfort.
- Mobilization: Ambulation and repositioning are encouraged as ordered to facilitate drainage and prevent complications like atelectasis. The drainage system must be carefully managed to remain below chest level during transport.
- Insertion Site Care: The dressing is assessed for integrity and signs of infection. Dressing changes are performed using aseptic technique according to hospital policy.
Troubleshooting and Complication Management
Nurses must be prepared to identify and respond to potential complications associated with chest drainage.
- Recognizing Complications: The nurse monitors for signs of respiratory distress, infection at the site, increased or excessive bloody drainage, and subcutaneous emphysema.
- Dealing with Air Leaks: If a persistent air leak is suspected (continuous bubbling), the nurse clamps the tubing momentarily starting at the patient's end to determine if the leak is in the system or coming from the patient.
- Accidental Disconnection or Dislodgement: In case of disconnection, the nurse clamps the tube temporarily, cleans the ends, and reconnects them. If the tube is dislodged from the patient's chest, a sterile occlusive dressing is immediately applied, taped on three sides, and the provider is notified.
Comparison of Wet vs. Dry Suction Systems
While both systems function to remove air and fluid, their nursing management and mechanisms differ.
| Feature | Wet Suction System | Dry Suction System |
|---|---|---|
| Mechanism | The amount of suction is controlled by the height of the water in the suction control chamber. | A regulator dial sets the suction level, eliminating the need for sterile water to regulate suction. |
| Bubbling | Gentle, constant bubbling is expected in the suction control chamber if suction is active. Vigorous bubbling means suction is too high. | A visual indicator, such as a bellows or float, shows that suction is working correctly. No constant bubbling is needed. |
| Set-Up | Requires filling the suction control chamber with sterile water to the prescribed level. | No sterile water is required for the suction control; simply connect to the wall suction and turn the dial. |
| Nursing Management | Requires frequent checks of the water level in the suction control chamber to ensure evaporation has not altered the suction level. | Requires checking the visual indicator and ensuring the dial is at the ordered setting. |
Patient and Family Education
Empowering the patient and family is a critical nursing responsibility. The nurse explains the purpose of the chest tube, teaches the patient about deep breathing and coughing exercises, and instructs them to report any breathing difficulty, excessive pain, or changes in the drainage or insertion site. The importance of keeping the drainage system below the chest is reinforced.
Conclusion
The responsibilities of a nurse regarding chest drainage are complex and vital. From initial assessment and setup to continuous monitoring, pain management, promoting mobility, troubleshooting complications, and patient education, the nurse plays an indispensable role. Safe and effective chest tube management requires clinical expertise and constant vigilance, directly contributing to positive patient outcomes. For more detailed clinical guidelines, nurses can refer to reliable medical resources like those found on the National Center for Biotechnology Information (NCBI) website, such as this overview on Care of a Chest Tube.
