What are three important nursing considerations for a chest tube?

Over 300,000 chest tubes are placed annually in the U.S. for various conditions. Understanding what are three important nursing considerations for a chest tube is crucial for patient safety and effective care.

Quick Summary

Effective chest tube care involves respiratory and drainage system assessment, pain management, and complication prevention and troubleshooting.

Key Points

• Patient and System Assessment: Assess respiratory status, vital signs, and monitor the chest tube drainage system.

• Effective Pain Management: Use pharmacological and non-pharmacological methods for comfort and activity tolerance.

• Complication Prevention and Management: Recognize and respond to issues like air leaks and accidental dislodgment.

• Proper System Function: Ensure the drainage system is positioned correctly and monitor tidaling.

• Emergency Preparedness: Keep emergency equipment ready for disconnections or dislodgment.

• Patient and Family Education: Educate on the tube's purpose and how to report issues.

Comprehensive Assessment of the Patient and Drainage System

A key nursing consideration involves the ongoing assessment of both the patient's condition and the drainage system.

Patient Respiratory Status

Regularly assess vital signs, oxygen saturation, and listen to breath sounds. Observe for respiratory effort and any signs of distress.

Drainage System Integrity and Function

Ensure the system is below chest level and airtight. Check tubing for kinks and document drainage. Monitor the water seal chamber for tidaling and continuous bubbling. Avoid milking or stripping tubing.

Effective Pain Management and Patient Comfort

Managing pain is vital for comfort and patient cooperation.

Pharmacological Interventions

Administer prescribed pain medications, such as analgesics or regional anesthesia.

Non-Pharmacological Strategies

Teach splinting for coughing and assist with positioning.

Promoting Comfort Through Activity

1. Encourage Deep Breathing and Coughing: Explain their importance.
2. Facilitate Ambulation: Assist with walking, managing the system correctly.
3. Provide Rest Periods: Ensure adequate rest.

Proactive Prevention and Management of Complications

Nurses prevent and manage complications, ensuring emergency equipment is available.

Air Leaks

Continuous bubbling indicates an air leak. Check systematically from the patient to the system to find the source.

Accidental Dislodgment or Disconnection

This requires immediate action to prevent tension pneumothorax.

• If the tube dislodges: Cover the site with a sterile occlusive dressing, tape on three sides, and notify the provider.
• If the tubing disconnects: Submerge the end in sterile water temporarily.

Comparison of Drainage System Indicators

Indicator	Normal Finding	Abnormal Finding	Nursing Action
Tidaling (Fluctuation)	Water level fluctuates with breathing.	No fluctuation or sudden stop.	Check for kinks; assess patient; notify provider.
Air Leak (Bubbling)	Intermittent bubbling with lung leaks; occasional bubbling on coughing.	Continuous, vigorous bubbling.	Troubleshoot leak; check connections and system integrity. Report persistent leaks.
Suction	Gentle bubbling (wet) or visible bellows/float (dry).	No bubbling (wet, if ordered); bellows/float incorrect level (dry).	Check suction source, tubing, water level (wet), and wall suction.
Drainage	Initially bloody, changing to serous; decreasing amount.	Sudden increase ($>$100 mL/hr) of bright red blood; cloudy/purulent fluid.	Assess vitals; notify provider immediately for bleeding or infection.

Conclusion

Diligent assessment, pain management, and complication prevention are vital for effective chest tube care. These actions enhance patient safety and recovery. {Link: NurseTogether https://www.nursetogether.com/chest-tube-insertion-nursing-diagnosis-care-plan/} and {Link: NCBI https://www.ncbi.nlm.nih.gov/books/NBK594490/} offer valuable information.

Frequently Asked Questions

Why is it important to keep the drainage system below the patient's chest level?

Keeping the system below the chest prevents fluid backflow into the pleural space.

What does tidaling in the water seal chamber indicate?

Tidaling confirms tube patency and system connection to the pleural space. Lack of tidaling could mean a blockage or re-expanded lung.

What is the primary concern if the chest tube becomes accidentally dislodged?

The main concern is a tension pneumothorax, where air builds up and compresses the heart and lungs.

When should continuous bubbling in the water seal chamber be a concern?

Continuous bubbling suggests a persistent air leak in the system that needs identification and correction.

Can a patient with a chest tube still ambulate?

Yes, ambulation is encouraged. The portable system promotes lung expansion.

What should a nurse do if they notice a sudden increase in bright red drainage?

A sudden increase in bright red drainage (e.g., >100 mL/hr) is an emergency indicating bleeding. Report this immediately.

Why is proper pain management so important for patients with chest tubes?

Good pain management allows patients to perform breathing exercises, coughing, and ambulation, aiding lung re-expansion and preventing complications.