6.6 Checklist: Set Up a Chest Tube Drainage System

*Disclaimer: Always follow agency policy and manufacturer recommendations

Checklist: Set Up a Chest Tube Drainage System^[1],[2]

Note: Refer to agency policy and the manufacturer’s guidelines before setting up a system.

• Verify the provider’s order to determine the type of drainage system to use.
• Gather the necessary equipment and supplies:
  • Single-use, disposable, sterile chest drainage collection unit (water-seal–wet-suction system, water-seal–dry-suction system, or dry-seal–dry-suction system)
  • Sterile water
  • Nonsterile gloves
  • Tape
  • Sterile dressing
  • Optional: commercial securement device, zip tie, suction source with regulator, and suction connection tubing
• Perform hand hygiene.
• Put on clean gloves.
• Maintain a sterile no-touch technique of the drainage system, including the tubing throughout the procedure.
• Remove any protective wrappers and prepare for setup. Stand the system upright. Use the floor or hangers on the unit. Attach the unit to bed frame, keeping the unit below the level of the insertion site of the chest tube.
• Add sterile water or sterile normal saline to the appropriate compartments according to the manufacturer’s instructions:
  • For a Two-chamber System Without Suction: Add sterile fluid to the water seal chamber to the required indicated level.
  • For a Three-chamber System With Suction: Add sterile fluid to the water seal chamber, typically to the 2 cm mark. Add sterile fluid to the suction control chamber, typically to the -20 cm mark. Connect the tubing from the suction control chamber to the suction delivery system (wall or portable).
  • For a Dry Suction System: Fill the water seal chamber with sterile solution, typically to the 2 cm mark. Adjust the suction control dial for the prescribed level of suction, typically between -10 to -40 cm. Connect the tubing from the suction control chamber to the suction delivery system (wall or portable). Do not occlude the suction control chamber when suction is used. On a dry suction system, do not occlude the positive-pressure relief valve because air will escape.
• Secure all tubing connections with tape or zip ties as indicated by agency policy.
• 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.

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