Promote oxygenation by encouraging the client to perform frequent position changes, deep breathing and coughing exercises, incentive spirometry, and ambulation as ordered.Observe the integrity of the drainage system tubing and chest tube every 1 to 4 hours according to agency policy and with any change in the client’s condition.Record the amount and characteristics of the drainage on the fluid input/output flow sheet and chart. Write the date, time, and amount of drainage on the outside of the collection chamber at the end of each shift and as indicated.Document the level of air leak, if it is constant or intermittent, or if the air leak occurs at rest or with coughing. If an air leak has been previously reported, assess the air leak meter according to the chest tube drainage system’s feature.Assess the water seal chamber for tidaling with respirations and ensure continuous bubbling is not occurring.Check the water seal chamber to ensure the water level is at 2 cm at least once every shift.If the chest tube is ordered to “water seal” (i.e., suction is not ordered), ensure the suction port is left open to air.Ensure the prescribed suction is set at the correct level.Avoid lifting the drainage system above the client’s chest.Avoid creating dependent loops, kinks, or pressure in the tubing.Coil the drainage system tubing and secure it to the edge of the client’s bed.Ensure tubing is not kinked or bent under the client or in the bed rails or compressed by the bed. Assess the chest tube drainage system to ensure the system is intact and to prevent accidental tube removal or disruption of the drainage system.Inspect and palpate the insertion site for subcutaneous emphysema. Assess the sterile dressing over the chest tube insertion site to ensure it is dry and intact.Ensure the unit is secured to prevent it from being accidentally knocked over. Ensure the chest tube drainage system is below the level of the insertion site and upright to prevent backflow of fluid from the tubing into the chest cavity.Increase monitoring if the client’s condition worsens. Continue assessing until the client is stable according to agency policy. Assessment should be at a minimum of every 15 minutes for the first hour immediately following chest tube insertion. Place the client in semi-Fowler’s position. Complete a focused respiratory assessment and pain assessment and analyze vital signs.Wear appropriate personal protective equipment (PPE) based on the client’s medical condition. Small container of sterile water or saline.Safety equipment should include the following: Ensure safety/emergency equipment is always at the client’s bedside and with the client during transportation to other departments.Explain the procedure to the client (and family members, if present).Confirm the client’s identity using at least two patient identifiers.Review the client’s medical record for allergies to antiseptic solutions and latex.Chest tube drainage systems are replaced only when the collection chamber is full or the system is contaminated or damaged. Prior to managing a client with a chest tube, review the indication for the chest tube, the location of the chest tube, recent volume of drainage and characteristics of the drainage, the date of previous dressing change, and any previously recorded air leak measurements or presence of subcutaneous emphysema.Verify the provider’s order regarding chest tube care and management.*Disclaimer: Always follow agency policy and manufacturer recommendationsĬhecklist: Manage a Closed Chest Tube Drainage System, 6.5 Checklist: Manage a Closed Chest Tube Drainage System
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