2-24

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2-24. CHEST TUBE INSERTION

a. General. Chest tube insertion (tube thoracotomy) is the insertion of one or more flexible tubes into the pleural space to remove air, blood, or fluid. This procedure is done by the physician.

b. Assembling the Necessary Equipment. Assemble the following:

(1) Thoracotomy tray (obtain from CMS).

 

(2) Sterile gloves.

 

(3) Padded hemostats.

 

(4) Suture material.

 

(5) Local anesthetic.

 

(6) Chest tube and connector.

 

(7) Chest drainage system: connecting tubing and collection bottles, or commercial system.

 

(8) Suction apparatus (if ordered).

 

(9) Mobile table or stand.

c. Preparation for the Procedure.

(1) Explain the procedure to the patient.

 

(2) Obtain and record vital signs.

 

(3) Assemble the drainage system.

 

(4) Set up and test the suction apparatus if one is ordered.

 

(5) Screen the patient and remove pajama coat to expose the chest. The insertion site will depend upon the presence of air or fluid.

 

(6) Position the patient as directed by the physician.

d. Assisting with Chest Tube Insertion.

(1) Set up the thoracotomy tray on the instrument table, using sterile technique.

 

(2) Using sterile technique, place other supplies on the sterile field.

 

(3) Assist the physician with the skin prep and administration of local anesthetic as for thoracentesis.

 

(4) Assist the physician with tube insertion, as directed. There are varying methods of introducing a tube into the pleural space. The method used depends upon the size of the tube to be inserted, the equipment available, and the physician's preference.

 

(5) The physician connects the patient's chest tube and the drainage tubing, checks the entire system to verify all connections, and tapes the connections to ensure an airtight system. He will then unclamp the chest tube. The clamps are never removed until the drainage system is airtight and ready to function.

 

(6) The chest tube is normally sutured in place and covered with a sterile dressing.

 

(7) Arrange for a follow-up chest X-ray, if ordered.

e. Follow-up Procedures.

(1) Remove equipment from bedside and care for properly.

 

(2) Observe patient for respiratory difficulty.

 

(3) Continue to observe the drainage system for proper function.

 

(4) Tape the padded hemostats and a package of sterile vaseline gauze to the head of the patient's bed. This equipment must be available for emergency use should the chest tube become dislodged or the drainage system opened.

 

(5) Record the procedure in the Nursing Notes. Note the patient's tolerance to the procedure.

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