During the Procedure: 1. Prepare the skin of the patient 2.

Assist the physician in the insertion of the tube 3. Ensure client safety and comfort. After the Procedure: 1. Observe drainage system for blood/air. Observe for fluctuation in the tube on respiration. 2. Secure follow-up chest x-ray. 3. Assess for bleeding, infection, leakage of air and fluid around the tube. 4. Discard waste materials in proper receptacles. 5. Document procedure done. 6. Check the chest tube connections periodically. Tape if necessary. 7. Mark the original fluid level with tape on the outside of the drainage bottle. Mark hourly/daily increments at the drainage level. 8. Make sure the tubing does not loop or interfere with the patients movements. 9. Encourage patient to assume position of comfort. 10. Put the arm and shoulder of the effected side through range-of-motion exercises several times daily. 11. Encourage patient to breathe deeply and cough at frequent intervals.

Sources: Lippincott Manual of Nursing Practice 5th edition pages 265 to 268 http://medical-dictionary.thefreedictionary.com/thoracostomy http://en.wikipedia.org/wiki/Chest_tube

August 8, 2012 Date

BENJO M. DELA CRUZ

Racquel O. De Villa, RN MAN Clinical Instructor