The Indispensable Role of the Nurse When Preparing for the Insertion of a Chest Tube, a Key Aspect of Patient Care

September 30, 2025 •

5 min read

According to research published by the NCBI, a team-based approach involving a registered nurse is proven to significantly reduce complications during chest tube insertion. This highlights the indispensable role of the nurse when preparing for the insertion of a chest tube, ensuring meticulous patient assessment, education, equipment readiness, and emotional support.

Quick Summary

The nurse's role prior to chest tube insertion involves a series of critical steps, including comprehensive baseline patient assessments, verifying informed consent, preparing sterile equipment, positioning the patient properly, and providing crucial emotional support to alleviate anxiety.

Key Points

Pre-Procedure Assessment: Nurses conduct a thorough baseline assessment of vital signs, respiratory status, medical history, and medications to establish a patient benchmark.
Informed Consent and Education: The nurse confirms informed consent and provides crucial patient education, reinforcing what to expect and addressing emotional concerns.
Equipment Preparation: Meticulous equipment readiness is a key nursing duty, which includes setting up the sterile thoracostomy tray, connecting the drainage system, and ensuring emergency supplies are present.
Patient Positioning: Correct patient positioning, often in semi-Fowler's with the arm abducted, is managed by the nurse to ensure optimal access for the provider.
Procedural Assistance: During the insertion, the nurse provides continuous patient monitoring, assists the provider, and offers verbal encouragement to maintain patient comfort.
Sterility and Safety: The nurse is responsible for maintaining sterile technique throughout the setup and insertion process to prevent infection.
Pain and Anxiety Management: Administering ordered sedatives or analgesics and providing emotional support are key parts of the nurse's role in managing the patient's pain and anxiety.

The Pre-Procedure Nursing Process

Preparation for a chest tube insertion is a multi-faceted process, with the nurse playing a pivotal role from the moment the procedure is ordered until the tubing is secured. Their responsibilities encompass a wide range of tasks designed to ensure patient safety, minimize anxiety, and facilitate a smooth and sterile procedure. The following sections detail the key actions and assessments performed by the nurse before a chest tube is inserted.

Comprehensive Patient Assessment

Before the procedure, the nurse conducts a thorough and systematic assessment of the patient. This baseline data is critical for monitoring the patient's condition for any changes during and after the insertion.

Key assessment points include:

Baseline Vital Signs: Recording the patient's heart rate, respiratory rate, blood pressure, and oxygen saturation is essential. Rapid or shallow breathing, decreased oxygen saturation, and changes in blood pressure can signal complications.
Focused Respiratory Assessment: The nurse auscultates breath sounds, noting any diminished or absent sounds in affected lung lobes. They also assess for dyspnea, use of accessory muscles, and symmetrical chest expansion.
Medical History and Medications: The nurse reviews the patient's chart for pre-existing conditions and medications. This is especially important for noting anticoagulants (e.g., warfarin, aspirin) or antiplatelets that increase bleeding risk.
Coagulation Profile: If ordered, the nurse ensures recent lab results, such as the International Normalized Ratio (INR), are available for the provider to review, as bleeding can be a complication.
Patient Knowledge and Anxiety: The nurse assesses the patient's understanding of the procedure and their level of anxiety, which is often heightened due to their respiratory distress.

Securing Informed Consent and Providing Emotional Support

While the healthcare provider is responsible for explaining the procedure and obtaining formal consent, the nurse reinforces this information and serves as a vital point of contact for the patient. The nurse's role includes:

Confirming Consent: The nurse ensures that the informed consent form has been properly signed by the patient or their representative. In emergency scenarios where consent cannot be obtained, this step may be omitted.
Patient Education: The nurse explains the benefits of the procedure, such as easier breathing with lung re-expansion, and what the patient can expect to feel, including pressure during insertion despite local anesthetic.
Anxiety Management: The nurse takes steps to reduce patient anxiety by explaining the process, reassuring the patient, and managing pain expectations. In cases of significant anxiety, the nurse may administer ordered anti-anxiety medications.
Respecting Privacy: Creating a private and calm environment is essential to put the patient at ease before the procedure.

Clinical and Logistical Preparation

In addition to patient-centered care, the nurse meticulously prepares the physical environment and necessary equipment to ensure a sterile and efficient procedure.

Equipment and Drainage System Preparation

The nurse is responsible for gathering and preparing all necessary equipment for the thoracostomy.

Gathering Equipment: A full thoracostomy tray is needed, which contains items such as scalpels, hemostats, syringes, needles, antiseptic solution, and suture material. The correct size of chest tube must also be selected and prepared.
Preparing the Drainage System: The nurse sets up the chest drainage system, such as a dry suction water seal unit. This involves filling the water seal chamber with sterile water to the specified level and preparing the suction port according to the manufacturer's instructions.
Connecting Suction: Once the system is ready, the nurse connects the wall suction and sets the prescribed level, ensuring the visual indicator (e.g., bellows or float) confirms it is functioning correctly.
Emergency Supplies: Crucial emergency supplies must be readily available at the bedside. These include two rubber-tipped clamps (for use only when changing the system or assessing a leak, never for routine clamping), sterile occlusive dressings (like petroleum gauze), and a small container of sterile water.

Patient Positioning and Site Preparation

Proper patient positioning is vital for both provider access and patient comfort, as it spreads the intercostal space for easier tube insertion. The exact position depends on the clinical condition and insertion site.

For Pneumothorax: The patient is often placed in a semi-Fowler's position with the arm on the affected side raised over their head to expose the midaxillary area.
For Hemothorax: If the patient can tolerate it, they may be positioned sitting on the side of the bed, leaning over a bedside table, with arms draped forward.
Site Preparation: The nurse prepares the insertion site by clipping excess hair and cleansing the area with an antiseptic solution using sterile technique.

Comparison of Roles: Nurse vs. Healthcare Provider


Aspect of Preparation	Nurse's Role	Healthcare Provider's Role
Patient Assessment	Gathers baseline vital signs, performs respiratory assessment, and reviews medical history and labs.	Identifies indications for chest tube, reviews patient data, and assesses overall clinical status.
Informed Consent	Reinforces provider education, clarifies benefits, addresses patient anxiety, and ensures consent is signed.	Explains risks and benefits of the procedure and obtains official informed consent from the patient.
Equipment Setup	Prepares the chest drainage system (filling water seal) and connects to suction.	Chooses the appropriate chest tube size and confirms the correct instruments are available in the sterile tray.
Patient Positioning	Positions the patient correctly based on the insertion site (e.g., semi-Fowler's, arm overhead) and provides support.	Confirms patient positioning and marks the precise insertion site with the nurse.
Site Preparation	Cleanses and preps the insertion site using sterile technique.	Performs skin incision and dissection to the pleural space.

The Nurse's Role During the Procedure

Once the healthcare provider begins the insertion, the nurse continues to play a vital support role. This includes:

Monitoring: Continuously monitoring the patient's vital signs and oxygen saturation to detect any immediate changes or complications, such as a tension pneumothorax.
Assisting: Passing equipment and maintaining a sterile field as requested by the provider.
Patient Support: Continuously reassuring the patient and encouraging normal breathing to help them remain calm.
Medication Administration: Administering any further analgesia or sedation as ordered by the provider.

The Immediate Post-Insertion Transition

As the procedure concludes, the nurse's role seamlessly transitions into post-procedure care. During this final preparation phase, the nurse assists with connecting the tube to the drainage system, securing the tubing, and applying the initial dressing. The final dressing, typically occlusive and airtight, is applied to the insertion site, and the tube is secured to the patient's chest wall to prevent dislodgement.

Conclusion

In conclusion, when preparing for the insertion of a chest tube, the role of the nurse is extensive and crucial for a successful and safe outcome. By performing comprehensive patient assessments, ensuring informed consent, meticulously preparing the equipment and patient, and providing continuous support during the procedure, the nurse serves as the patient's primary advocate. This coordinated, team-based effort, with the nurse at the forefront of patient care, significantly minimizes procedural risks and helps facilitate a positive patient experience during a stressful medical event.

Frequently Asked Questions

The very first step for the nurse is to obtain and document baseline vital signs and a focused respiratory assessment, which serves as a critical point of reference for monitoring the patient's condition.

The nurse confirms that the healthcare provider has obtained informed consent from the patient and reinforces the explanation of the procedure, its benefits, and what the patient can expect during the process.

A nurse prepares the thoracostomy tray, sets up the chest drainage system (including filling the water seal chamber), connects the suction, and ensures emergency supplies like rubber-tipped clamps and sterile dressings are at the bedside.

For a typical anterior or lateral insertion, the nurse positions the patient in a semi-Fowler's position, with the arm on the affected side raised and placed behind their head to expose the chest wall.

The nurse must review the patient's medications, particularly any anticoagulants or antiplatelet drugs, as these increase the risk of bleeding, a potential complication of the procedure.

If a patient's vital signs significantly change, particularly if they show signs of worsening respiratory distress or instability, the nurse must immediately notify the healthcare provider.

Yes, a nurse can administer pre-procedure medications, such as analgesics, sedatives, or prophylactic antibiotics, as ordered by the healthcare provider to manage pain, anxiety, and prevent infection.