Overview of Chest Tubes
A chest tube (thoracostomy tube) is a flexible tube inserted into the pleural space
to remove air, blood, fluid, or pus, allowing lung re-expansion.
Indications for Chest Tubes
Pneumothorax (air in the pleural space)
Hemothorax (blood in the pleural space)
Pleural effusion (excess fluid in the pleural space)
Empyema (pus due to infection)
Postoperative drainage (e.g., after lung surgery or trauma)
Chest Tube Components & Drainage System
Insertion Sites:
Air removal: 2nd–4th intercostal space, midclavicular line
Fluid removal: 5th–6th intercostal space, midaxillary line
Types of Drainage Systems
1. Water Seal (Traditional 3-Chamber System)
o Collection chamber (drains fluid/air)
o Water-seal chamber (prevents air from re-entering)
o Suction control chamber (regulated via water level)
2. Dry Suction System
o Uses a dial for suction control instead of water
Chest Tube Management for Nurses
Assessment & Monitoring
Assess the patient:
Respiratory status: Breath sounds, SpO₂, effort
Pain management: Pre-medicate if needed
Inspect the drainage system:
Drainage color & amount (report if >100mL/hr of bright red drainage)
Water seal chamber: Should have tidaling (fluctuations with breathing)
Bubbling in the water-seal chamber:
o Intermittent bubbling = normal (air leaving pleural space)
o Continuous bubbling = air leak (check connections, notify
provider)
Check tube & connections:
Ensure tubing is not kinked or clamped unnecessarily
Keep drainage system below chest level to prevent backflow
Encourage deep breathing, coughing, incentive spirometry
Suction Settings:
Prescribed by the provider (usually -20 cm H₂O)
Complications & Nursing Actions
Complication Signs/Symptoms Nursing Actions
Continuous bubbling in water- Check connections, reinforce
Air Leak
seal chamber dressing, notify provider
Tube falls out, sudden respiratory Apply occlusive dressing (3
Dislodgment
distress sides), call provider immediately
Tension Tracheal deviation, absent breath Notify provider, prepare for
Pneumothorax sounds, JVD, hypotension needle decompression
Fever, redness, purulent Monitor for signs of infection,
Infection
drainage at site maintain sterile technique
Chest Tube Removal
Done when drainage is minimal & lung re-expands
Pre-removal nursing care:
o Medicate for pain
o Explain the process
o Have a petroleum gauze dressing ready
Post-removal care:
o Assess for respiratory distress
o Monitor for recurrent pneumothorax (chest X-ray)
o Apply an occlusive dressing
Quick Do’s & Don’ts for Nurses
Do:
Keep drainage system below the chest
Monitor for signs of respiratory distress
Encourage coughing, deep breathing, & mobility
Check for air leaks & secure tubing
Don’t:
Clamp the chest tube unless ordered
Milk or strip the tubing (can increase pressure)
Lift the drainage system above chest level
Ignore continuous bubbling in the water-seal chamber
