Nursing Care
Respiratory Assessment & Care
Indications
Goal of therapy is to remove air or fluid
from the pleural space.
• Pneumothorax (Air)
• Hemothorax (Blood)
• Chylothorax (Chyle/Lympathic Fluid)
• Empyema (Pus)
• Pleural Effusion (Fluid)
Attach Suction Tubing Tubing attached
Here to Chest Tube
See Orange Float
Suction Control Chamber
• Dial in the ordered suction level (most
commonly it is -20 cm). When suction is
applied an orange float will be visible in the
window beside this chamber.
Water Seal Chamber
• This consists of a tube submerged under 2 cm
of water that functions like a one-way valve:
As the patient breathes spontaneously, the air
passes through the water as he exhales. When
he inhales, the water barrier prevents air from
going into his chest. This helps reestablish
negative intrapleural pressure. (Bubbling
indicates an air leak)
Drainage Collection Chamber
• This reservoir is where drainage accumulates
as it is drained from the chest. Markings
indicate fluid level.
• Respiratory Rate & Characteristics, Breath Sounds, SpO2
• Elevate Head of Bead
• Turn every 2 hours; increase activity as ordered
• Encourage Coughing/Deep Breathing & use of Incentive
Spirometry
• Pain Assessment & Management (Very Important!)
Chest Tube & Drainage System
• Palpate the insertion site for subcutaneous emphysema.
• Assess if site dressing is occlusive. Do not use petroleum
gauze at site unless ordered.
• Secure connections between chest tube and drainage
system with tape.
• Verify suction is set as ordered and that orange float is
visible.
• With an order, CT may be placed to water seal (d/c
suction) to see if lung remains expanded & the chest tube
is no longer needed.
• Monitor the amount and characteristic of drainage
o Minimal drainage if placed for air removal.
• Keep drainage system upright and below level of chest.
• Avoid dependent loops in the tubing by loosely coiling the
tube on the bed & allow the rest of tubing to fall in a straight
line to the drainage unit.
• Accumulation of drainage in the tubing impedes suction.
Lift the tubing & empty drainage into the collection chamber
as needed.
• Assess water seal chamber for:
o Fluctuations

Water column will move
with inspiration and 
with expiration; movement is opposite if patient is on
a ventilator. Presence indicates the system is
properly functioning.

May be minimal if system is placed to suction.
o Bubbling

Indicates an air leak;
• Check all connections between the chest tube &
drainage system
• Reinforce dressing
• Notify physician.

If chest tube is placed for a pneumothorax, bubbling
may be present until the lung has reexpanded.
• Never clamp a chest tube.
• Never strip a chest tube. If clot is seen, gently squeeze or
pinch the tubing between the fingers in the direction of
the drainage device.
• If the chest tube becomes dislodged, immediately apply
an occlusive dressing, and tape three sides. Notify
physician.