1. CHEST TUBE
CARE
By: Vanessa Morton, Student Nurse
Front Range Community College
Senior Practicum Teaching Project

2. Chest tube basics
What are chest tubes?
 flexible plastic tubes
 inserted through the side of the chest and
into the pleural space
 used to drain contents from the
intrathoracic space
 tubes are connected to A
chest drainage canister

3. Chest tube basics
What is a drainage canister?
 a drainage canister is
typically used to collect
chest tube contents (air,
blood, or effusions)
 can hold up to 2000 ml of
fluid
 Typically there are three
chambers: the drainage
collection chamber, the
water seal chamber, and
the suction control
chamber
 Can be connected to
suction or can be used
with gravity
 Needs to stay below the
level of the patient’s
chest

4. Chest tube basics
When are chest tubes used?
 After surgery or trauma
 Pneumothorax
 hemothorax
 Air leaks from the lung into the chest
 pneumothorax
 Bleeding into the chest
 hemothorax
 Collection of fat in the chest
 chylothorax
 Lung abscesses or pus in the chest
 empyema

5. Pneumothorax
a collection of air or gas in the pleural cavity
of the chest between the lung and the chest
wall

6. Hemothorax
a condition that results from blood
accumulating in the pleural cavity

7. Chylothorax
a type of pleural effusion resulting from
lymphatic fluid (chyle) accumulating in the
pleural cavity

8. Empyema
a collection of pus within a naturally existing
anatomical cavity, such as the lung pleura

9. More about drainage canisters
One-bottle system
 simplest set up
 first tube submerged
in 2 cm water creates
a water seal
 second tube
connected to wall
suction
 excessive
accumulation of fluid
can cause decreased
function of the unit

10. More about drainage canisters
Two-bottle system
 separate bottles for
collecting drainage
and for the water seal
 air from the pleural
space travels from the
collecting bottle to
the water seal bottle
and exits into the
atmosphere
 separate bottle for
drainage means more
fluids can be collected
before a new bottle is
needed

11. More about drainage canisters
three-bottle system
 separate bottles for
collecting drainage,
for the water seal,
and for suction
control
 level of fluid in the
suction control
bottle determines the
amount of suction
provided
 rarely used due to
bulkiness

12. More about drainage canisters
Plastic Multi-Chamber
System
 Commercially available
 Incorporates the three
bottle system into one
unit

13. Plastic Multi-Chamber System
• Three separate chambers
– Drainage collection chamber
– Water seal chamber
– Suction control chamber

14. Drainage collection chamber

15. Water seal chamber

16. Suction control chamber

17. Chest tube site care
dressing changes
• vary depending on each facility’s
policies and procedures
However, dressing changes
are always completed using:
• Sterile technique
• An occlusive dressing

18. Supplies always
Kept at the bedside
sterile normal saline
 Used If tubing gets disconnected
 submerge the end of the chest tube
(1 to 2 inches or 2-4 cm) below the surface of sterile
normal saline to establish a water seal, allowing air to
escape and preventing air from re-entering
petroleum gauze
 used to cover the chest incision if the tubing is
accidently removed
 allows air to escape from the incision, and prevents air
from entering the incision
 depending on the facility’s policies and procedures, 3 or
sometimes all 4 sides of the gauze can be taped down to
the patient’s skin

19. If you think something is
wrong…
Always assess the patient first…then the equipment!
-check for signs of respiratory
Distress
-assess level of chest pain
-listen to lung sounds

20. If you think something is
wrong…
Always assess the patient first…then the equipment!
-check the patient’s heart rate
-check the patient’s dressing
-check the drainage system,
The tubing, and the suction

21. When should you call the
doctor?
-Any signs of increased respiratory distress
-New onset or worsening crepitice
-Signs of a clogged chest tube (blood clot in tube)
-Hypovolemic shock
-Any signs of increased air leakage
-Greater than 100 cc of drainage in one hour for two or
more hours
-Worsening vital signs (increased heart rate,
respiratory rate, temperature)

22. References
Cabggroupassignment.wikispaces.com, (2011). Care of a Patient With a Chest Tube.
Retrieved from http://cabggroupassignment.wikispaces.com/Group+Three+-
+Care+of+a+patient+with+chest+tubes
Hkresp.com, (2009). Nursing Management of Chest Drains. Retrieved from
http://www.hkresp.com/index.php/administrator/152-pleural-diseases/578-2009-dec-
nursing-management-of-chest-drains
Respiratorytherapycave.blogspot.com, (2011). Chest Tubes and Pleural Drainage Systems.
Retrieved from http://respiratorytherapycave.blogspot.com/2011/10/chest-tubes-
and-pleural-drainage.html