Chest tube assessment and care


Complications resulting in the need for a chest tube:

  1. Pleural effusion
  2. Hemothorax
  3. Empyema (pus)
  • Symptoms:


  1. Dyspnea
  2. Cough
  3. Chest Pain
  4. Fever
  5. Malaise


Mediastinal Chest tube purpose:

  • removal of blood or fluid from around the heart



  1. Volume of drainage (date and time)
  2. Suction Rate
  3. Nature of drainage (measure and character)
  4. mark on pneumothorax container then replace when full


Drainage System Troubleshooting:

  • No tidling indicates the system is not patent or that lungs have expanded to normal
  • Intermittent bubbling is normal, if continuous bubbling occurs the tube has been displaced
  • rapid bubbling may indicate air leak around incision or tear in pulmonary pleura



  1. Patient
  2. Site
  3. Tubing
  4. Timing = q15min for first hr after insertion, then q4h


Patient Assessment:

  1. vital signs
  2. oxygen saturation
  3. level of orientation
  4. respiratory assessment
  • signs and symptoms of increased respiratory distress:
  • displaced trachea
  • decreased breath sounds over both affected and unaffected sides
  • marked cyanosis
  • asymmetrical chest movements
  • chest pain:
  • sharp, stabbing chest pain – indicative of tension pneumothorax
  • pain on inspiration – indicative of hemothorax or pneumothorax
  • hypotension
  • tachycardia
  • pain scale
  1. Hg and Hct


Site assessment:

  1. Chest tube Dressing and surrounding insertion site -norm = Dry and Intact
  2. Drainage
  3. Subcutaneous emphysema
  4. Sudden increase in drainage of more than 70ml may indicate new thoracic bleeding


Tubing assessment:

  • tight system connections
  • appropriately taped
  • tubing not kinked, or obstructed
  • prevent dependent loops
  • avoid milking or stripping the drainage in tubing


Drainage Unit Chambers:

  • Set upright
  • insure drainage collector is below the level of the patient`s chest
  • ensure tidling is occurring with patient inspirations and expiration
  • lung re-expansion may have occurred if no tidling occurs and 2-3 days have passed
  • An air leak may be indicated by fluid bubbling left to right when facing system.
  • assess the suction level is as per doctors orders
  • sudden halt in drainage may indicate clot or other blockage in the drainage system
  • Know expected drainage colour when assessing


Clamp tubing (but only for seconds) when:

  • locating leaks
  • replacing the system
  • as per physicians orders to trial if pneumothorax has resolved
  • 2 non-toothed clamps should be at the patient`s bedside at all times

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