6.5 Checklist: Manage a Closed Chest Tube Drainage System

*Disclaimer: Always follow agency policy and manufacturer recommendations

Checklist: Manage a Closed Chest Tube Drainage System^[1],[2]

• Verify the provider’s order regarding chest tube care and management.
• 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. Chest tube drainage systems are replaced only when the collection chamber is full or the system is contaminated or damaged.
• Review the client’s medical record for allergies to antiseptic solutions and latex.
• Gather the appropriate equipment:
  • Vital signs monitoring equipment
  • Stethoscope
  • Pulse oximeter and probe
  • Disinfectant pad
  • Facility-approved disinfectant
  • Marker
• Perform hand hygiene.
• Confirm the client’s identity using at least two patient identifiers.
• Provide privacy.
• Explain the procedure to the client (and family members, if present).
• Ensure safety/emergency equipment is always at the client’s bedside and with the client during transportation to other departments. Safety equipment should include the following:
  • Two rubber-tipped clamps
  • Sterile water
  • Petroleum-infused gauze
  • 4” × 4” sterile dressings
  • Occlusive dressing or waterproof tape
  • Small container of sterile water or saline
  • Alcohol swabs
• Wear appropriate personal protective equipment (PPE) based on the client’s medical condition.
• Complete a focused respiratory assessment and pain assessment and analyze vital signs. Place the client in semi-Fowler’s position.
• Assess the client. Assessment should be at a minimum of every 15 minutes for the first hour immediately following chest tube insertion. Continue assessing until the client is stable according to agency policy. Increase monitoring if the client’s condition worsens.
• 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. Ensure the unit is secured to prevent it from being accidentally knocked over.
• Assess the sterile dressing over the chest tube insertion site to ensure it is dry and intact. Inspect and palpate the insertion site for subcutaneous emphysema.
• Assess the chest tube drainage system to ensure the system is intact and to prevent accidental tube removal or disruption of the drainage system. Ensure tubing is not kinked or bent under the client or in the bed rails or compressed by the bed.
• Coil the drainage system tubing and secure it to the edge of the client’s bed.
• Avoid creating dependent loops, kinks, or pressure in the tubing.
• Avoid lifting the drainage system above the client’s chest.
• Ensure the prescribed suction is set at the correct level.
• If the chest tube is ordered to “water seal” (i.e., suction is not ordered), ensure the suction port is left open to air.
• Check the water seal chamber to ensure the water level is at 2 cm at least once every shift. Add sterile water as necessary.
• Assess the water seal chamber for tidaling with respirations and ensure continuous bubbling is not occurring.
• If an air leak has been previously reported, assess the air leak meter according to the chest tube drainage system’s feature. Document the level of air leak, if it is constant or intermittent, or if the air leak occurs at rest or with coughing.
• Write the date, time, and amount of drainage on the outside of the collection chamber at the end of each shift and as indicated. Record the amount and characteristics of the drainage on the fluid input/output flow sheet and chart.
• 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.
• Promote oxygenation by encouraging the client to perform frequent position changes, deep breathing and coughing exercises, incentive spirometry, and ambulation as ordered.
• Discard used supplies, remove gloves, and perform hand hygiene.
• Help the patient into a comfortable position and place personal items, the tray table, and the call light within easy reach. Make sure the patient knows how to use the call light to summon assistance. To ensure the patient’s safety, raise the appropriate number of side rails and lower the bed to the lowest position. Ensure the bed is locked.
• Perform hand hygiene.
• Document the procedure, assessments, and interventions.

Documentation Cues:

• Date and time that chest tube drainage system was initiated
• Type of chest tube drainage system used
• Location and size of chest tube inserted
• Amount of suction applied to the pleural cavity (if applicable)
• Presence or absence of bubbling or fluctuation in the water seal chamber (if applicable)
• Teaching provided to the client and family, understanding of education, and any need for follow-up teaching