Chest Tube Management and Care: An Overview for Nurses

Chest tube placement is a life-saving medical procedure, and understanding the management and care of patients with chest tubes is critical for nurses. Before assessing the chest tube or patient, it is important to know if the drainage system should be hooked up to continuous wall suction or water seal. Also, confirm that suction control is dialed to correct pressure, and the drainage system is kept below the level of the chest. The next step is to assess the chest tube and patient. First, look for crepitus, which occurs when gas or air leaks into the subcutaneous layer of the skin. This can indicate an air leak or the need for a dressing change. Notify the doctor if crepitus is felt.Second, the water in the water seal chamber should oscillate; specifically, the level will move up during inhalation and move down during exhalation. When there is no oscillation in the chamber, check the line for kinks.Third, assess respiratory status and auscultate lungs for any sound changes. Air leaks, an extended pneumothorax, or a hemothorax can put the patient in respiratory distress.Fourth, keep the dressing clean, dry and intact. Monitor for signs of infection, and if the dressing becomes soiled change the dressing per hospital policy.Fifth, excessive bubbling in the water seal chamber indicates an air leak in the system. Assess the system for possible causes. However, gentle intermittent bubbling should be expected with patients that have known pneumothorax. Occasionally quick interventions may be required if the following situations arise. If the tube dislodges from the patient, the insertion site should be covered with sterile occlusive dressing (petroleum gauze) taped on 3 sides. Finally, if the drainage system is damaged in any way, insert the patient’s chest tube into a bottle of sterile water. Keep the bottle below the level of the chest until a new drainage system can be delivered.