What are Chest Tubes and What Procedures Require Them?

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DiaMedical
Published on July 23, 2021 at 2:13:00 PM PDT July 23, 2021 at 2:13:00 PM PDTrd, July 23, 2021 at 2:13:00 PM PDT

The lungs are surrounded by membranes called pleura. The pleural space between these membranes has a tiny amount of fluid in it. This fluid keeps the lungs expanded as people breathe in and out. Extra fluid, blood, or air in the pleural space can cause the lung to collapse. A chest tube is inserted into the pleural space between the lungs and the chest wall to remove extra air and fluid to keep the lung expanded. A common misconception would have you believe the tube enters the lungs but A chest tube does not go into the heart or lungs. A chest tube is connected to a drainage system that collects fluid and allows air to escape. 

When is a Chest Tube Necessary?

Pneumothorax occurs when air leaks into the space between the lung and chest wall. This is the most common reason for a chest tube. The air pushes against the lung and causes it to collapse. Sometimes a lung can collapse without warning, which is called a spontaneous pneumothorax. Traumatic pneumothorax occurs as a result of a chest injury. Tension pneumothorax is a life-threatening condition that develops when a chest injury acts as a one-way valve. Air enters the chest with each breath but cannot escape. The windpipe and heart can be pushed aside as air accumulates in the chest. The heart and blood vessels can collapse and the person will die without a chest tube. 

Pleural effusion is the build-up of excess fluid in the pleural space around the lungs. Infections, cancer, liver failure, and heart failure can cause pleural effusion. A chest tube is used to drain the fluid so that the person can breathe. Small Pneumostat chest tubes are designed for people with illnesses that cause chronic pleural effusions. People can drain fluid at home with this type of chest tube to breathe more easily.  


Nursing Care for Patient With A Chest Tube

 

The nurse carefully assesses the patient at least every 2 hours, including respiratory rate and how hard the patient has to work to breathe. The nurse will listen to the patient’s chest with the stethoscope to hear the air going in and out of the lungs. No air will be heard in areas where a lung has collapsed. The nurse ensures that the chest tube is not kinked and the drainage box is kept below the patient’s chest. 

The amount of fluid from the chest tube is measured every few hours. Suction can be used to help remove fluid from the chest. Bubbling in the water seal chamber of the drainage box indicates that an air leak is present. If this occurs, the tubing connections must be sealed securely. Sterile Vaseline gauze is tucked around the tube where it enters the chest to prevent air leaks. Dry sterile gauze is applied over the top and taped securely in place. The tubing can be gently rolled between the fingers to break up any clots or clogs that form in the drainage fluid. 

The nurse also manages problems that can occur with the patient’s chest tube. If the tube is accidentally pulled out, the site is covered with a sterile dressing and taped on only 3 sides. This allows air to escape if needed when the patient exhales. The doctor is notified immediately. If the drainage tubing breaks, the end is placed into a bottle of sterile water or sterile saline to create a temporary water seal until a new chest tube system is obtained. The chest tube is never clamped except when the drainage box is being replaced.  

Nurses also help prevent complications from chest tubes. Chest tubes are very uncomfortable and effective pain management is important for the patient. The patient should use an incentive spirometer hourly to help promote fluid drainage and prevent atelectasis (collapse of air sacs within the lungs). Patients can walk in the hall with a chest tube as long as the drainage box is kept below chest level. The box can be attached to the IV pole instead of carrying it. 

Conclusion

Lungs can collapse if air or fluid accumulates in the pleural space between the lungs and the chest wall. Chest tubes are used to keep lungs expanded so that people can breathe easily. People with certain chronic illnesses may even go home with chest tubes. Nurses carefully monitor patients with chest tubes to make sure that the lungs stay expanded and no air leaks develop. Chest tubes are uncomfortable but they are very important to keep lungs expanded so people can breathe easily. 

DiaMedical offers a chest tube management training bundle for healthcare program instructors. It was created by the DiaMedical Nurse Educator to include all needed equipment and supplies. Skills include assessment of patients with chest tubes, dressing changes, identification of air leaks, and suction adjustment. Learning materials are provided for students and guidance for chest tube simulations is offered for instructors. For more information, reach out to a DiaMedical expert at 877-593-6011 or info@diamedicalusa.com