Skills: Chest Tube: Management - CE Page 1 of 8 QUICK SHEET ALERT Stripping the chest tube is contraindicated because doing so results in transient high negative pressure in the pleural space, which can be detrimental to tissues in the pleural space. Patients with a pneumothorax/air leak and closed drainage system with suction applied require a physician’s order to discontinue the suction. Removing suction or clamping a pleural drain in the presence of an air leak may result in a tension pneumothorax. Assessments are done at the beginning of each shift and/or as per FH care standards and will include: Reportable conditions: https://point-of-care.elsevierperformancemanager.com/print 06/07/2021 Skills: Chest Tube: Management - CE Page 2 of 8 Safety Equipment per Unit Policy may include; Assessment https://point-of-care.elsevierperformancemanager.com/print 06/07/2021 Skills: Chest Tube: Management - CE Page 3 of 8 Dressing Change 1. Wash hands 2. Check patient identity using two patient identifiers. 3. Position patient in a comfortable semi-fowlers position, usually on a bed. 4. Assess need for breakthrough analgesia. 5. Establish clean working area – cleanse surface using a bactericidal wipe and allow time to dry. 6. Gather supplies. 7. Wash hands. Don (PPE) personal protective equipment. 8. Prepare sterile field using dressing tray. 9. Open supplies onto sterile field. 10. Using clean gloves, remove old dressing if necessary. 11. Assess chest tube site and surrounding skin for signs and symptoms of infection and presence of suture (large bore chest tubes). 12. Perform hand hygiene and don sterile gloves. 13. Cleanse around chest tube insertion site with saline soaked gauze including tube and allow time to dry. 14. Apply drain sponges around tube. (If needed, you may add additional support under the tube by folding 4 x 4 gauze underneath the tube.) https://point-of-care.elsevierperformancemanager.com/print 06/07/2021 Skills: Chest Tube: Management - CE Page 4 of 8 15. Place 4 x 4 gauze over chest tube on top of drain sponge. 16. Secure dressing with adhesive tape. 17. When applicable, select securement device. 18. Ensure all connections in chest drainage system are secure (see below). 19. Ensure prescribed suction settings and the presence of the orange float ball in the indicator window. Closed chest tube drainage systems using wall suction must be connected via a suction canister to prevent any accidental intake of fluids into the system. 20. Ensure drainage tubing is unobstructed with no dependent loops and connections are secured with tape or tie tape. Securement All connections from the chest tube to the closed drainage system must be secured with waterproof tape or ties. https://point-of-care.elsevierperformancemanager.com/print 06/07/2021 Skills: Chest Tube: Management - CE Page 5 of 8 Flushing a Pigtail Catheter with NS 4. Perform hand hygiene. 5. Apply clean gloves and don personal protective equipment (PPE). 6. Establish presence of 3-way stopcock attached between the pigtail catheter and the closed drainage system connection tubing. https://point-of-care.elsevierperformancemanager.com/print 06/07/2021 Skills: Chest Tube: Management - CE Page 6 of 8 https://point-of-care.elsevierperformancemanager.com/print 06/07/2021 Skills: Chest Tube: Management - CE Page 7 of 8 Clamping Pleural chest tube(s) should only be clamped when changing the chest drainage unit, assessing air leaks, or with physician’s order. Sampling (Fluid from a Chest Tube) https://point-of-care.elsevierperformancemanager.com/print 06/07/2021 Skills: Chest Tube: Management - CE Page 8 of 8 https://point-of-care.elsevierperformancemanager.com/print 06/07/2021
