CHEST TUBE THORACOSTOMY CARE

DEFINITION:
Chest Drainage – is the insertion of a tube into the pleural space to evacuate air, fluid, or to
help regain negative pressure.

Thoracostomy – is an incision made into the thoracic cavity.

PURPOSE:
1. Chest tube thoracostomy care is given to maintain the patency and integrity of the
drainage system.

N
ASSESSMENT:
1. Assess the client’s respiratory status, including RR and oxygen saturation and lung

O
sounds.
2. Assess the client for pain.
3. Assess the client’s understanding of the importance of the chest tube.

SPECIAL CONSIDERATIONS:
1. Change dressing according to hospital policy.
C
2. The entry of a small amount of air is not as dangerous as the potential for tension
pneumothorax or cardiac tamponade.
U
3. Do not clamp the chest tube during transport or ambulation unless specifically ordered
by the doctor.
4. Clamping the chest tube in patients with an air leak increases the chance for
pneumothorax.
N

5. Make the level of drainage in each column and add to calculate the total drainage.
6. Notify doctor if character of drainage is a significant change.
D

EQUIPMENT/SUPPLIES:
1. Bottle of sterile normal saline or water
2. Two pairs of padded Kelly clamps
3. Pair of non-sterile scissors
A

4. Disposable gloves
5. Foam tape or bands
6. Pen or marker

This instructional material is exclusively for ADNU College of Nursing only.. Reproduction, sharing and distribution is
strictly not allowed unless permitted by the owner.
IMPLEMENTATION:
Suggested Action Rationale

1. Check physician’s orders. This ensures accuracy and prevents errors.

2. Review chart for client’s limitations in This ensures accuracy and prevents
physical activity. mistakes and mobility.

3. Prepare the materials needed.

4. Perform hand hygiene. This prevents cross contamination and

further spread of infection.

N
5. Introduce yourself to the client. Introducing yourself could alleviate the
fear of the client and gain cooperation.

O
6. Identify the client by asking for the name This confirms the identity of the client.
or checking the identification band.

7. Explain the procedure to client. Explaining the procedure could alleviate

the fear of the client.

8. Assess client’s status.

9. Adjust the bed to the appropriate height.

C Care is always individualized according to
the client’s needs.

Lower the siderails on the working side.

U
10. Provide privacy. This is basic to human dignity and
provision of privacy demonstrates respect.

11. Don gloves. This reduces microorganism transfer.

N

12. Expose chest tube insertion site. This facilitates proper assessment and
visualization of the site.
D

13. Check the dressing and make sure that it An occlusive dressing would ensure that
is occlusive. complications (such as subcutaneous
emphysema) are prevented.

14. Palpate gently around the insertion site. This helps in the assessment of
A

subcutaneous emphysema.

15. Check drainage tubing for dependent This position facilitates drainage.
loops or links. The drainage collection device
must be positioned below the tube insertion
site.

16. Place a bottle of sterile water or normal The sterile bottle will be needed in case
saline at the bedside. chest tube is accidentally separated from
the drainage.

This instructional material is exclusively for ADNU College of Nursing only.. Reproduction, sharing and distribution is
strictly not allowed unless permitted by the owner.
Suggested Action Rationale

17. If the chest tube is ordered to be

suction, assess the amount of suction set
on the chest tube against the amount of
suction ordered.

18. Observe for any bubbling or tidaling in Fluid fluctuations (tidaling) in the water seal
the suction chamber. chamber or air leak indicator area area
indications that the lung has reexpanded, the
tubing is obstructed and the suction is not
working

N
19. Mark the level on the container or
place a small piece of tape at the drainage
level to indicate date and time.

O
20. Get two (2) pairs of padded Kelly
clamps, new drainage system, and bottle
of sterile water.

21. Note color and amount of drainage.

22. Apply Kelly clamps 1.5” to 2.5” from

insertion site and 1” apart, going to
opposite directions.
C Chest tubes are only clamped under specific
circumstances per physician order or nursing
policy and procedure.

23. Prepare new drainage system. Don This reduces microorganism transfer.
U
disposable gloves.

24. Remove the suction from the drainage

system.
N

25. Unfold the band or use scissors to cut

away any foam tape on connection of
chest tube drainage system.
D

26. Remove the drainage system using a The twisting motion will facilitate careful
twisting motion. removal of the drainage system.

27. Keeping the end of the chest tube

sterile, insert the end of the new drainage
A

system into the chest tube.

Note: Reconnect suction if ordered.

28. Put plastic bands or foam tape to

chest tube/drainage system connection
site.

This instructional material is exclusively for ADNU College of Nursing only.. Reproduction, sharing and distribution is
strictly not allowed unless permitted by the owner.
Suggested Action Rationale

29. Remove Kelly clamps.

30. Assess drainage system for

continuous bubbling, tidaling, and
amount of suction applied.

31. Place client in a comfortable A comfortable position improves

position. well-being.

32. Place needed items and call bell Facilitates comfort, provides ready access

N
within client’s reach. for communication.

33. Raise side rails and lower the bed Prevent accidental falls.
to the lowest position.

O
34. Dispose used gloves. Prevents spread of infection.

35. Perform hand hygiene. Reduces spread microorganisms.

DOCUMENTATION:

1. Document the
tube, amount and
amount of suction
C
site of the chest Documentation provides a means for
type of drainage, communication, evaluation of care and
applied, and any outcomes.
U
bubbling, tidaling, or subcutaneous
emphysema noted.

2. Document the type of dressing in

N

place and client’s pain level as well as

any measures performed to relieve the
client’s pain.
D
A

CHEST TUBE THORACOSTOMY CARE

Suggested Actions Correctly Partially Not Remarks
Done Done Done

1. Check physician’s orders.

This instructional material is exclusively for ADNU College of Nursing only.. Reproduction, sharing and distribution is
strictly not allowed unless permitted by the owner.
2. Review chart for client’s limitations in
physical activity.

3. Prepare the materials needed.

4. Perform hand hygiene.

5. Introduce yourself to the client.

6. Identify the client by asking for the name or

checking the identification band.

7. Explain the procedure to client.

N
8. Assess client’s status.

9. Adjust the bed to the appropriate height.

O
Lower the siderails on the working side.

10. Provide privacy.

11. Don gloves.

12. Expose chest tube insertion site.

13. Check the dressing and make sure that it is

occlusive.
C
U
14. Palpate gently around the insertion site.

15. Check drainage tubing for dependent loops

or links. The drainage collection device must be
N

positioned below the tube insertion site.

16. Place a bottle of sterile water or normal

saline at the bedside.
D

17. If the chest tube is ordered to be suction,

assess the amount of suction set on the chest
tube against the amount of suction ordered.
A

18. Observe for any bubbling or tidaling in the

suction chamber.

19. Mark the level on the container or place a

small piece of tape at the drainage level to
indicate date and time.

Suggested Actions Correctl Partially Not Remarks

y Done Done Done

This instructional material is exclusively for ADNU College of Nursing only.. Reproduction, sharing and distribution is
strictly not allowed unless permitted by the owner.
20. Get two (2) pairs of padded Kelly clamps, new
drainage system, and bottle of sterile water.

21. Note color and amount of drainage.

22. Apply Kelly clamps 1.5” to 2.5” from insertion site

and 1” apart, going to opposite directions.

23. Prepare new drainage system. Don disposable

gloves.

24. Remove the suction from the drainage system.

N
25. Unfold the band or use scissors to cut away any
foam tape on connection of chest tube drainage
system.

26. Remove the drainage system using a twisting

O
motion.

27. Keeping the end of the chest tube sterile, insert

the end of the new drainage system into the chest
tube.

Note: Reconnect suction if ordered.

28. Put plastic bands or foam tape to chest

tube/drainage system connection site.
C
U
29. Remove Kelly clamps.

30. Assess drainage system for continuous bubbling,

tidaling, and amount of suction applied.
N

31. Place client in a comfortable position.

32. Place needed items and call bell within client’s

D

reach.

33. Raise side rails and lower the bed to the lowest
position.
A

Suggested Actions Correctly Partially Not Remarks

Done Done Done

34. Dispose used gloves.

This instructional material is exclusively for ADNU College of Nursing only.. Reproduction, sharing and distribution is
strictly not allowed unless permitted by the owner.
35. Perform hand hygiene.

DOCUMENTATION:

a. Document the site of the chest tube,

amount and type of drainage, amount of
suction applied, and any bubbling, tidaling, or
subcutaneous emphysema noted.

b. Document the type of dressing in place Good

and client’s pain level as well as any measures job!
performed to relieve the client’s pain.

N
ATTITUDE CRITERION

O
3 2 1 Score Remarks

Behavior

Compliance to prescribed uniform

Completion
(assignment,
of other Tasks
reflection, journal,
C
etc.)
U
Time Efficiency

Total Score
N

EQUIVALENT
D

_________________________________ __________________________
Signature of Student Over Printed Name Date
A

_______________________________________ __________________________
Signature of Clinical Instructor Over Printed Name Date

This instructional material is exclusively for ADNU College of Nursing only.. Reproduction, sharing and distribution is
strictly not allowed unless permitted by the owner.