Running head: CARE AND USE OF DIFFERENT TYPES OF CHEST TUBES 1

Care and Use of Different Types of Chest Tubes

Courtney Robinson

Norquest College

Nursing Foundations 2003-002

Assignment 1: Research and Application to Nursing Care

Sonya Dichoso

August 25, 2020

CARE AND USE OF DIFFERENT TYPES OF CHEST TUBES 2

Introduction

“The purpose of chest tubes and pleural drainage is to remove the air and fluid from the

pleural space and to restore normal intrapleural pressure so that the lungs can re-expand” (Lewis

et al., 2019, p. 626).

According to Lewis et al. (2019):

A chest tube is inserted through a thoracotomy incision, either anteriorly through the

second intercostal space to remove air or posteriorly through the eighth or ninth

intercostal space to remove blood and fluid. Afterwards the tube is sutured to the chest

wall and covered with an impermeable dressing. The tubes are kept clamped during

insertion. After the tubes are placed in the pleural space, they are connected to the

appropriate drainage system and suction.

Using sterility, concepts from the nursing metaparadigm and evidenced-based

practise, nurses can provide safe, holistic care to clients with chest tubes.

Previous Practise in Medical-Surgical Nursing

Throughout the years, there have been various changes made to improve the chest tube

system itself and through these changes, many factors have developed to ensure safety of the

client.

Previously ‘stripping’ or ‘milking’ tubing in a chest tube system was a normal practise to

dislodge clots that may be attached to the sides of the tubes by mechanically squeezing them

distally to the collection container. Lewis et al. (2019) states that this traditional practise to

maintain patency of the chest tube is no longer recommended because it can produce

dangerously high intrapleural pressure and damage to pleural space. Recent chest tubes are made
CARE AND USE OF DIFFERENT TYPES OF CHEST TUBES 3

with a coating that makes them nonthrombogenic, so blood and drainage are not likely to clot

inside.

Another practise no longer advocated is clamping of the chest tube when the tube is

unintentionally disconnected or during transport. “The danger of rapid accumulation of air in the

pleural space causing tension pneumothorax is far greater than that of a small amount of

atmospheric air entering the pleural space” (Lewis et al., 2019, p. 628). Clamping of the chest

tube may be done briefly when checking for air leaks, assessing client’s tolerance for removal or

when the health care professional needs to change the drainage device.

Promoting the Health of the Medical-Surgical Client

There is a various number of strategies us as nurses can use to promote the health of our

clients. Keeping the nursing metaparadigm in mind, we must remember that the client’s internal

and external environment can influence their health and recovery (environment concept),

maintain confidentiality and provide respect (nursing concept) to establish a beneficial nurse-

client relationship.

One strategy, as listed in Potter, Perry, Stockert, & Hall, is developing personal skills.

Potter et al. (2017) states developing personal skills can include health education, but also

emphasizes adequate support and resources. Being able to provide resources and support to

clients in need ties into the concept of justice.

Lewis et al. (2019) states the nurse should promote deep breathing periodically,

facilitating lung expansion and encourage range of motion exercises of the affected side

shoulder. Incentive spirometry every hour while awake may help to prevent atelectasis or

pneumonia.
CARE AND USE OF DIFFERENT TYPES OF CHEST TUBES 4

More opportunities to promote the health of the medical-surgical client would be

completing pain assessments, then interventions for pain management, providing adequate

nutrition, and the use of sterility. “Infection at the skin site is a concern. Meticulous sterile

technique during dressing changes can reduce the incidence of infected sites” (Lewis et al., 2019,

p. 628).

Health Teachings of the Medical-Surgical Client

Health teaching is a priority to promote the health of the medical-surgical client.

“Education empowers patients to improve their health status. When patients are involved in their

care, they are more likely to engage in interventions that may increase their chances for positive

outcomes” (The Nurse’s Role in Patient Education, 2018, para. 2). Teachings should start as

early as admission and continue until discharge. Upon discharge, the client should know signs of

infection (increased pain at the surgical site, hardness/redness/warmth of incision, and

development of drainage or change in character of drainage) and activities they can do to lower

their chance of developing pneumonia (continuing with deep breathing exercises, avoid smoking,

and complete any medications prescribed to them in full). Ensuring the client has received the

correct teachings, understands them, and allowing the client to be involved in their own health

relates to the concept of person in the nursing metaparadigm.

Conclusion

In using the nursing metaparadigm, nursing theories, sterility, and related nursing

knowledge, nurses can provide holistic care for clients with chest tubes. Nurses can promote

their client’s health by applying principles of teaching and learning related to chest tubes by

establishing a respectful, professional nurse-client relationship.

CARE AND USE OF DIFFERENT TYPES OF CHEST TUBES 5

References

Arkansas State University. (2018). The nurse’s role in patient education. Retrieved from

https://degree.astate.edu/articles/nursing/nurses-role-patient-education.aspx

Lewis, S. L., Bucher, L., Heitkemper, M. M., Harding, M. M., Barry, M. A., Lok, J., Tyerman,

J., & Goldsworthy, S. (2019). Medical-surgical nursing in Canada. (4th ed.). Milton, ON:

Elsevier.

Potter, P. A., Perry, A. G., Stockert, P. A., & Hall, A. M. (2019). Canadian fundamentals of

nursing. (9th ed.). Milton, ON: Elsevier.

Student Name: Courtney Robinson

CARE AND USE OF DIFFERENT TYPES OF CHEST TUBES 6

Actual Nursing
Planning Interventions Evaluation
Diagnosis
Goal Intervention Goal met:
Ineffective breathing The client’s breathing pattern Teach client to use incentive
pattern related to will improve and they will be spirometer every hour when awake as The client could
decreased lung expansion able to breathe without using this will facilitate lung expansion and demonstrate use of the
as evidenced by use of their accessory muscles. reduce atelectasis. spirometer and explained
accessory muscles, its purpose.
shortness of breath,
abnormal ABG’s and The client’s respiratory
states, “My pain is a 5- Literature Support rate is within the
10”. Lewis, S. L., Bucher, L., Heitkemper, acceptable range at 10-20
M. M., Harding, M. M., Barry, M. A., breaths per minute and
Lok, J., Tyerman, J., & Goldsworthy, the breathing is relaxed
S. (2019). Medical-surgical nursing in and regular.
Canada. (4th ed.). Milton, ON: Elsevier.
SpO2>95%

Intervention Upon assessment of the

Outcome Medicate with analgesics, as client, they did not use
The client will be able to appropriate, to promote deeper accessory muscles to
establish a normal, effective respiration. Pain can cause clients to breathe and
breathing pattern with ABG’s breath shallow, putting them at risk demonstrated deep,
and respirations within client’s for atelectasis. controlled, effective
normal range or acceptable breathing.
range within the eight-hour
shift. Symmetrical chest
Literature Support expansion was observed
Doenges, M. E., Moorhouse, M.F., & when the client took a
Murr, A. C., (2019). Nurse’s pocket deep inhale and exhale
guide. (15th ed.). Philadelphia, PA: F.A. (chest expansion is
Davis Company. unequal with marked
atelectasis or
Intervention pneumonia).
Encourage range of motion exercises
of the affected side shoulder. Breath sounds were clear
upon auscultation over
the client’s lung fields.

Literature Support ABG values for the client

Lewis, S. L., Bucher, L., Heitkemper, were between the
M. M., Harding, M. M., Barry, M. A., acceptable ranges:
Lok, J., Tyerman, J., & Goldsworthy,  Arterial pH =
S. (2019). Medical-surgical nursing in 7.35-7.45
Canada. (4th ed.). Milton, ON: Elsevier.  Arterial partial
pressure of
carbon dioxide
(PaCO2) = 35-
45 mm Hg
 Arterial partial
pressure of
oxygen (PaO2)
= 80-100 mm
Hg
Pain assessment done
and client states, “My
pain is much better, only
1-10 now”.

Potential Nursing
Planning Interventions Evaluation
Diagnosis
Risk of trauma related to Goal Intervention Goal met:
dependence on external The client to not experience Make sure drainage system is secured
device as evidenced by trauma due to the chest to the client’s bed or drainage stand Drainage system is
client having a chest drainage system. and is upright, on a level lower than secured to drainage stand
drainage system. the client’s chest. Explain to the client and is upright. Client
that if it was elevated at the level of verbalized back to the
their chest fluid could drain back into nurse if the level of the
the lungs. It needs to be secured to drainage system is at
CARE AND USE OF DIFFERENT TYPES OF CHEST TUBES 7

prevent it from accidentally being their chest or higher, fluid

knocked over. could drain back into the
lungs.

Client demonstrated using

Literature Support their call bell for
Lewis, S. L., Bucher, L., Heitkemper, assistance when they
M. M., Harding, M. M., Barry, M. A., needed to go to the
Lok, J., Tyerman, J., & Goldsworthy, washroom.
S. (2019). Medical-surgical nursing in
Canada. (4th ed.). Milton, ON: Elsevier. Chest tube tubing coiled
loosely below client’s
Intervention chest level and has no
Outcome Ensure the client knows to use their dependent loops. Client
The client will recognize the call bell and wait for assistance before verbalized that they
need for assistance to prevent ambulating (ex: to go to the understand that
complications as well as washroom). Explain to the client that dependent loops could
understand the chest drainage the drainage system needs to be lead to increased pressure
system immediately after the carried at the level below their chest within the lung due to
nurses teaching in and the tubing and connections need obstruct drainage.
postoperative care. to be checked that they are secure.

Literature Support
Lewis, S. L., Bucher, L., Heitkemper,
M. M., Harding, M. M., Barry, M. A.,
Lok, J., Tyerman, J., & Goldsworthy,
S. (2019). Medical-surgical nursing in
Canada. (4th ed.). Milton, ON: Elsevier.

Intervention
Ensure tubing is coiled loosely below
chest level and has no dependent
loops. Dependent loops should be
avoided as they obstruct drainage into
the collection system and increase
pressure within the lung.

Literature Support
Lewis, S. L., Bucher, L., Heitkemper,
M. M., Harding, M. M., Barry, M. A.,
Lok, J., Tyerman, J., & Goldsworthy,
S. (2019). Medical-surgical nursing in
Canada. (4th ed.). Milton, ON: Elsevier.

Teaching Nursing
Planning Interventions Evaluation
Diagnosis
Risk for surgical site Goal Intervention
infection related to The client will remain infection Review and educate client on Goal met:
thoracotomy chest tube free. reportable symptoms (post discharge)
surgery secondary to lack such a fever (especially if trending The client could repeat
of knowledge evidenced upwards), increased pain in surgical back reportable
by client stating, “I don’t site, hardness/redness/warmth of symptoms.
know how my wound incision, development of drainage or
should look like”. change in character of drainage (ex: The client could repeat
from serosanguinous to blood-tinged back why eating
exudate). nutritious food and snacks
and drinking enough
fluids is important in
preventing infections.
Literature Support Client ensured nurse that
Doenges, M. E., Moorhouse, M.F., & they have access to
Murr, A. C., (2019). Nurse’s pocket nutritious food.
guide. (15th ed.). Philadelphia, PA: F.A.
Davis Company. The client could repeat
CARE AND USE OF DIFFERENT TYPES OF CHEST TUBES 8

back and demonstrate

Intervention proper incision care
Outcome Advise client to eat nutritious foods techniques. The client
The client will be able to and snacks and have adequate fluid demonstrated washing
identify signs and symptoms of intake. Good nutrition helps the body their hands with
an infection, know ways of build and repair tissues and heal antibacterial soap,
preventing infection, and incisions, as well as boost the immune wetting their wrists and
explain proper incision care system to protect against infection. hands under running,
techniques before being Adequate fluid intake helps boost your warm water, lathering
discharged home. immune system to reduce chances of their hands and wrists
infection. together for at least 15-
20 seconds (interlacing
their fingers, rubbing the
palms and the backs of
Literature Support their hands in a circular
Doenges, M. E., Moorhouse, M.F., & motion at least five times
Murr, A. C., (2019). Nurse’s pocket each, rinsing, then drying
guide. (15th ed.). Philadelphia, PA: F.A. fingers to wrists).
Davis Company.

Intervention
Instruct client in incision care as per
doctor’s orders and receive return
demonstration. This includes
demonstrating to the client performing
proper hand hygiene to prevent
infection. After removal of the chest
tube, the site is covered with an
airtight dressing, the pleura seals itself
off, and the wound heals in several
days.

Literature Support
Doenges, M. E., Moorhouse, M.F., &
Murr, A. C., (2019). Nurse’s pocket
guide. (15th ed.). Philadelphia, PA: F.A.
Davis Company.

Lewis, S. L., Bucher, L., Heitkemper,

M. M., Harding, M. M., Barry, M. A.,
Lok, J., Tyerman, J., & Goldsworthy,
S. (2019). Medical-surgical nursing in
Canada. (4th ed.). Milton, ON: Elsevier.