Name: _______________________________________Date: ___________________Year & Section: _____

PROCEDURE CHECKLIST FOR ASSISSTING CHEST TUBE INSERTION

NCM 112 SL

Legend: Done Student performs consistently in an effective and efficient manner

Not Done No progress in performance has been demonstrated and/or

Performance is consistently ineffective and inefficient

Done Not Remarks

Done
EQUIPMENT
 36 French chest tube (for adult)
 Chest drainage system (disposable or three-bottle)
 Sterile water (bottle)
 5 in 1 connector or Y connector (for 2 chest tubes)
 Sterile gloves and masks
 Disposable gloves
 Dressing (Vaseline gauze, split drain sponge, 4x4sd 3 inch tape)
 Rubber shod Kelly clamps
 Chest tube-insertion tray (povidone-iodine, local anaesthetic, syringe, needles,
drapes, scalpel, suture)
Procedure:

1. Verify doctor’s order. Obtain consent

2. Assess patient; vital signs, respiratory and cardiac status, anxiety, pain.
3. Explain procedure to patient/family.
4. Wash hands.
5. Verify site of insertion
6. Prepare a chest drainage system, per physician preference, using sterile
technique to open packages, handle contents, and pour solutions.
7. Don sterile gloves; recap connectors when finished.
 One-bottle system: add sterile water to submerge water-seal tube.
 Two-bottle system: add sterile water to submerge water seal tube; connect
water seal bottle to collection bottle.
 Three-bottle system: add sterile water to submerge water seal tube, connect
water seal bottle to collection bottle, ensure that long tube is submerged,
connect suction bottle then to suction regulator
 Disposable system: swivel base of unit to stand upright, remove cap on suction
control chamber and add sterile water to 20 cm level, replace cap, remove cap
on water-seal chamber tubing and use catheter tip syringe to add water to 2 cm
level, replace cap on tubing, and inspect system for leaks or cracks.
8. Assist physician as needed with chest tube insertion, maintain sterile
technique, don sterile gloves and mask. Monitor patient’s physical and
emotional response to procedure.
9. Once chest tube is inserted, connect it to the long tube of collection
chamber of chest drainage system and remove rubber-shod Kelly. If
suction is ordered, attach short water-seal tubing to suction tubing and
regulator. Keep unclamped if no suction has been ordered.
10. Apply dressing: Vaseline gauze, drain sponge, 4x4s and tape. Tape all
connections.
11. Adjust suction until gentle bubbling occurs in suction control chamber.
12. Ensure tubing is free of kinks and is loosely coiled or forms straight line
to drainage system.
13. Observe for air bubbles in water-seal chamber and fluctuations, tidaling,
with respiration.
14. Position chest drainage system upright and below level of chest.
15. Secure bottles in stand or disposable system to bed frame.
16. Order chest X-ray
 17. Mark fluid level on collection chamber and time of measurement. Use
tape if needed to write on.
18. Encourage patient to breathe deeply, cough and change positions.
19. Assess drainage and vital signs, notify physician for changes in drainage
quantity or character, especially change from serous to bloody.
20. Keep rubber-shod Kelly clamps at bedside.
21. Document the procedure and findings.

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Signature of Students Signature of Clinical Instructor