#37

37) Discuss the nursing care of the client with a chest tube.
Pg. 1325-1326

• Chest tubes inserted into pleural cavity to restore negative pressure and drain collected fluid or blood
• Insertion and removal require sterile technique and must be done without introducing air or microorganisms into the pleural cavity.

Test Tube and Drainage System responsibilities:

• monitor and maintain the patency and integrity of the drainage system
• Assess the clients vital signs, O2 Sat, cardiovascular status, and resp. status
• Keep rubber tipped clamps and sterile occlusive dressing near the client. If tube becomes disconnected from the collection system, submerge the end in 1 in. of sterile saline or water to maintain the seal. If the chest tube is inadvertently pulled out, the wound should be immediately covered with a dry sterile dressing. If you can hear air leaking out the site, ensure that the dressing is not occlusive. If the air cannot escape, this would lead to pneumothorax.
• Use standard precautions and personal protective equipment while manipulating the system and assisting w/insertion or removal.
• Observe the dressing site at least every 4 hrs. Inspect the dressing for excessive and abnormal drainage, such as bleeding or foul-smelling discharge. Palpate around the dressing site for a crackling sound indicative of subcutaneous emphysema which can result from poor seal at the chest tube insertion site
• Determine level of discomfort with and w/out activity and medicate client for pain if indicated.
• Encourage deep breathing and coughing exercises every 2 hrs (may be contraindicated in clients who have had lung removed). Have client sit upright to perform excercises, and splint the chest around the tube insertion site with a pillow or hand to minimize discormfort.
• Rerposition client every 2 hrs. When the client is lying on the affected side, placed rolled towels beside the tubing. Frequent position changes promote drainage, prevent complications, and provide comfort. Rolled towels prevent occlusion of the chest tube by the clients weight.
• Assist the client w/ ROM exercises of the affected shoulder 3 times a day to maintain joint mobility
• When transporting and ambulating the client:

a. Attach rubber tipped forceps to clients gown for emergency use
b. Keep water sealed unit below chest level and upright
c. Disconnect the drainage system from the suction apparatus before moving the client
and make sure the air vent is open