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Nursing Situation: Pleural Effusion with Thoracentesis and Chest Tube
Summer A. Hill
Christine E. Lynn College of Nursing Florida Atlantic University
NUR4716L Acute Care in Nursing Situations with Adults and Aging Populations in Practice
Dr. Maude Exantus, FNP-BC, DNP
June 8, 2022
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Nursing Situation: Pleural Effusion with Thoracentesis and Chest Tube
C.L. is a 55-year-old male who presents to his health care provider with complaints of
difficulty breathing, which has progressively worsened over the past couple of weeks. He has
a history of hypertension. He is currently taking hydrochlorothiazide (Diovan HCT) and
lisinopril (Zestril).
Subjective Data
Has had some shortness of breath for the past couple of weeks. At first, it was just with
activity, but it has gotten worse and is present at rest.
Started smoking at age 18 and has smoked one pack per day for the past 37 years
Adds he has cut down on his smoking the past week and is only smoking one-half pack of
cigarettes per day
Objective Data
Physical Examination
Blood pressure 140/88, pulse 90, temperature 98.7° F, respirations 22
O2 saturation 90% on room air
Respirations labored, frequent productive cough with yellow sputum
Breath sounds reveal distant breath sounds in right lower lobe, clear in all other lobes
Dullness to percussion of right lower lung lobe
Diagnostic Studies
Chest x-ray reveals a 2.5 cm lesion and pleural effusion in the right lower lung
Discussions Questions:
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1. What is a pleural effusion? What type of effusion do you suspect C.L. has and
why?
Pleural effusion refers to an abnormal and excessive buildup of fluid between the layers
of tissue that line the lungs and chest cavity. There are two types of pleural effusion –
transudative or pneumothorax (caused by leaking of fluid into the pleural space), and exudative
or hemothorax (caused by blocked blood vessels, inflammation, lung injury, and tumors)
(Pleural Effusion: Medlineplus Medical Encyclopedia, n.d.). In this case, we might suspect that
C.L. is experiencing hemothorax as a result of years of smoking and subsequent lung damage, as
well as his shortness of breath.
2. The health care provider performs a thoracentesis to alleviate C.L.’s dyspnea and
to have the fluid analyzed for diagnostic purposes. What is the procedure for a
thoracentesis? What tests and monitoring is done after the procedure?
A thoracentesis is performed to remove fluid from the pleural space. The procedure is
performed using a needle that is inserted through the skin and the muscles of the chest wall and
into the space around the lungs. Fluid is then drawn out through the needle before it is removed.
It is important that the patient remain still and not cough or breathe deeply during the procedure
(Thoracentesis: Medlineplus Medical Encyclopedia, n.d.)
Case Study Progress The results of the thoracentesis revealed malignant cells in the
pleural fluid. C.L. then has CT scans of the chest, brain, and bone to evaluate the exact location
and size of the lung mass and check for any mediastinal or lymph node involvement and
metastatic disease. The results of the CT scan show only the 2.5 cm lesion in the lower lobe of
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the right lung with no evidence of mediastinal or lymph node involvement and metastasis. C.L.
undergoes a thoracotomy with a right lower lobectomy. After this surgery, he is admitted to the
surgical step-down unit with a chest tube.
3. What is the purpose of the chest tube?
A chest tube is inserted for C.L. to ensure there is drainage of the excess fluid around the
lungs to allow for reinflation.
4. Describe how you will maintain C. L.’s chest tube drainage system.
In order to maintain the chest tube drainage system it is important to monitor the patient
and look for any signs of infection or dislodgement. Goals will be to restore adequate
oxygenation, promote lung reexpansion, and prevent complications by implementing a plan of
care that includes:

Providing adequate pain management per provider’s orders.

Administering antibiotics as ordered

Maintaining suction and oxygen

Monitoring the chest tube insertion site for signs of infection.

Elevating the head of the bed to 30 degrees to help the patient breathe easier.

Monitoring the patient's vital signs for signs of distress and perform continuous pulse
oximetry to watch for hypoxemia.

Running Labs: assess ABG’s s for adequate oxygenation and ventilation.

Measuring drainage every 8 hours.

Encouraging the patient to practice deep breathing.

Encouraging smoking cessation
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Maintaining tube patency by avoiding dependent loops in the drainage tube and any
aggressive chest tube manipulation.
(Pruitt, 2008)
The drainage system should always be kept below C.L.’s chest and the tubing should be
kept free from any kinks or loops (Chest Tubes Nclex Review, 2016)
5. What would you do if the chest tube drainage system breaks?
If the chest tube system breaks I would be sure to notify the provider right away. I would
insert the tube 1 inch into a bottle of sterile water or sterile normal saline and obtain a new
system (Chest Tubes Nclex Review, 2016).
6. What assessments will you include for this client?
I would be sure to monitor patient vitals and assess lung sounds – rate and signs of
dyspnea. I would look for any indications of worsening pneumothorax. I would also assess skin
for signs of infection such as crepitus, and I would be sure to move C.L. frequently and
encourage deep breathing and coughing (Chest Tubes Nclex Review, 2016)
7. When will the chest tube be removed? Describe the procedure for chest tube
removal.
A chest tube is usually ready to be removed when:

the drainage has decreased to little or none

air stops exiting the chest

the patient is stable and breathing normally

breath sounds are at baseline

fluctuations in the water seal chamber have stopped
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
a chest X-ray shows that the fluid or air accumulation is resolved.
(Pruitt, 2008)
Procedure for chest tube removal is as follows:

Gather supplies: sterile gloves, dressing supplies, mask, goggles, suture removal kit, tape,
rubber tipped hemostats, etc.

Educate patient prior to remove and how to do the Valsalva’s maneuver – the patient will
take a deep breath, exhale, and bear down (prevents air for going back into pleural space).
This will be performed by the patient when tube is removed.

Pre-medicate for pain if ordered by physician.

Position patient in Semi-Fowler’s for removal.

Monitor respiratory status, lung sounds, drainage, assess chest for unequal chest rising,
and dyspnea. Patient should have chest x-ray after removal. Be sure this is included in
provider’s orders.
(Chest Tubes Nclex Review, 2016)
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References
Chest tubes nclex review. (2016, August 5). Registered Nurse RN.
https://www.registerednursern.com/chest-tubes-nclex-review/
Pleural effusion: Medlineplus medical encyclopedia. (n.d.).
https://medlineplus.gov/ency/article/000086.htm
Pruitt, B. (2008). Clearing the air with chest tubes. Men in Nursing, 3(6), 32–37.
https://doi.org/10.1097/01.min.0000342529.63826.61
Thoracentesis: Medlineplus medical encyclopedia. (n.d.).
https://medlineplus.gov/ency/article/003420.htm