Care of the Patient

with Chest Tube

Drainage
NURS 342

mpbq Fall 2010

Objectives
At the end of this
presentation the student will
be able to:
1. define the purpose of
chest tubes.
2. explain the components
of the system.
3. discuss nursing
interventions related to
chest tubes.
mpbq Fall 2010

Lungs
Two membranes
Visceral (pulmonary) pleura
Lungs
Parietal
Thoracic cavity
Serous fluid

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Normal Lung Condition

Always negative pressure in pleural cavity
Keeps two pleurae in contact
Keeps lung pulled up against chest wall
Degree of negativity changes during
respiration
Deeper breath intrapleural pressure more
negative
Mechanical attachment of pleura plus residual
vol. keep lungs from collapsing

mpbq Fall 2010

Disruption of Normal Lung

Condition
Air or fluid enters pleural space
Separates pleura
Disrupts negative pressure
Needed to prevent lung collapse at end expiration

Compresses lung
Small amounts of air or fluid can be re-absorbed
Larger amounts of these foreign substances must
be evacuated

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Pneumothorax: Open and

Tension

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Purposes of Chest Tubes

Re-expand the involved lung

Remove excess air, fluid, and

blood
Re-establish normal intrathoracic
pressures.
Facilitate re-expansion and
restore normal breathing dynamics
mpbq Fall 2010

Chest Drainage
Used to treat spontaneous and traumatic pneumothorax
Used postoperatively to re-expand the lung and remove
excess air, fluid, and blood.
Types of drainage systems
Traditional water seal
Dry suction water seal
Dry suction
Management
Prevention of cardiopulmonary complications

mpbq Fall 2010

Traditional Water Seal

Also referred to as wet suction
Has three chambers: a collection chamber,
water seal chamber (middle chamber), and wet
suction control chamber
Requires that sterile fluid be instilled into water
seal and suction chambers. Has positive- and
negative-pressure release valves. Intermittent
bubbling indicates that the system is
functioning properly. Additional suction can be
added by connecting system to a suction
source
mpbq Fall 2010

Dry Suction Water

Seal
Also referred to as dry suction
Has three chambers: a collection chamber,
water seal chamber (middle chamber), and wet
suction control chamber
Requires that sterile fluid be instilled in water
seal chamber at 2-cm level. No need to fill
suction chamber with fluid. Suction pressure is
set with a regulator. Has positive- and negativepressure release valves. Has an indicator to
signify that the suction pressure is adequate.
Quieter than traditional water seal systems
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Dry Suction
Also referred to as one-way valve system
Has a one-way mechanical value that allows air
to leave the chest and prevents air from
moving back into the chest
No need to fill suction chamber with fluid; thus,
can be set up quickly in an emergency. Works
even if knocked over, making it ideal for
patients who are ambulatory

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Components of Chest Tube

Drainage System
First chamber- collects the fluid

Second chamber- water seal to prevent air

from entering the pts pleural space; Bubbling
of water indicates air drainage from pt. & is
seen in exhalation, coughing, & sneezing

Third chamber- for suction control

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Interventions in Caring for

Patients with Chest Tubes
Secure taping at junctions

Occlusive dressing at site

Sterile gauze & sterile water at bedside

Padded clamps at bedside *But no routine

clamping!
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Interventions (cont.)
. Prevent kinks & large loops of tubing

6. NO vigorous stripping of chest tube

7. Assess respiratory status

8. Document drainage- type & amount & mark

it on container
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Heimlich Valve

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Reference
Smeltzer et al. (2010). Brunner & Suddarths
Textbook of medical-surgical nursing (12th ed.).
Philadelphia: Lippincott Williams & Wilkins.

Acknowledgement
Contributions of Dr. Nancy Blasdell and
Professor Nan Griffin in developing previous
versions of this presentation.

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