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Published by: mara5140 on Dec 23, 2008
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NUR 2744 Advanced Medical Surgical
Chest Tube Nursing Information and Care

Purpose: The purpose of a chest tube is to
evacuate and collect air, and or fluid from the
chest cavity or the mediastinum.
Data to support: The visceral and parietal pleura form a potential

intrathoriac space that is filled with approximately 4 ml. of lubricating
pleural fluid. Between these two membranes, which line the chest wall and
cover the lungs there is a fluctuating but always negative intrapleural

Disruption of the lungs, thorax, or pleura may be caused by disease, chest trauma, needle biopsy, surgery, or a thoracentesis and can enable air and of fluid to flow into the pleural space.

The insertion of a chest tube connected to a water seal or a one way

drainage system restores normal respiratory function when the integrity of the pleural space is interrupted. The location of the device will be based on what the initial problem is.

\ue000Ifair must be drained-placement will be near the apex of the lung
oRationale-Free air will rise to the highest point
\ue000Iffluid must be drained-placement will be near the base of the lung,
usually in the 4th to 6th intercostal space.
oRationale- Gravity will pull fluid down to the lung bases.
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Types of Chest DrainageUnits-
\ue000Chest drainage unit (CDU): Traditional chest drainage unit consists of a
collection chamber, water seal chamber, suction control chamber; can
drain large amounts of fluid or air
\ue000Smaller/lighter portable CDU: Mechanical one-way valve instead of water
seal chamber; good for patient who needs drainage only (not suction to
reexpand lung), such as noncomplicated pneumothorax
\ue000Heimlich valve: Contains a one-way flutter valve; air drains out when
patient exhales; keep collection device upright and vented to prevent air
\ue000Indwelling pleural catheter: Drains chronic pleural effusions; drains fluid
only; can be done at home every 1 or 2 days or when short of breath
Nursing Care of Chest Tubes and Chest Drainage Units-
Entry Site-
Patient Air Leak Meter
Drainage Collection-
\ue000Clamping- This action requires a physicians\u2019 orders. Reasons why you
would clamp a chest tube are:
Clamp the tube only long enough to hook up another tube, to
prevent air from being sucked back into the chest.
\ue000Transporting-Always keep the collection chamber below the level of the
insertion site.
\ue000Disruption- What if the chest tube gets pulled out by mistake?

Keep the Vaseline gauze by the bedside. Put the gauze onto the
site of the chest tube insertion. Occlude the opening. you don\u2019t
want air going back into the patient\u2019s chest. Call the physicians and
get a state chest x-ray order..

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\ue000Milking and Stripping-

Stripping is controversial.. The idea is that if a chest tube is \u201cmilked\u201d every couple of hours after, say, a surgical procedure, then it won\u2019t get plugged up by clots, which only makes sense, since if the tube gets plugged, then the air and fluid that it\u2019s supposed to remove will not get removed, and a tension situation could develop in the chest.


But stripping and milking can pull too hard suction-wise on the
chest cavity, possibly causing tissue injuries to the lung. Consult
with the physician about the action to take if this situation arises. If
you\u2019re instructed not to strip, watch carefully for signs that the chest
tube is still working properly: draining air, fluid, or blood. If air were
to stop coming out three hours postop a lobectomy , page the

\ue000Dressing Changes-Consult your hospital policy and procedure for the
schedule of dressing changes. Observe the site for drainage being careful
to chart the color, amount, and type in your patients chart.
\ue000Trouble Shooting-There a few links listed below that you can refer to for

more information on many types of chest tubes and the possible trouble
shooting techniques. Please note that there are many different types of
chest drainage units. It is important to always refer to your agencie\u2019s policy
and procedure for the current and correct ways to care for a patient with
chest tube drainage.

\ue000For this reason we have attached one local area agency policies. See
attached to this handout.
\ue000Please always know that your agencies policies will govern what you

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