1
SAN JOSE STATE UNIVERSITY
School of Nursing
Nursing 155
Care of the Client with Closed Chest Drainage
KEY
Learning Resources
1.
Elkin, M., Perry, A., & Potter, P. (2004). Nursing interventions and clinical skills (3rd ed.,
pp. 202, 775-784). St. Louis, MO: Mosby.
2.
Lewis, S.M.., Heitkemper, M.M., & Dirksen, S.R. (2005). Medical-surgical nursing:
Assessment and management of clinical problems. (6th ed., pp. 620-625). St. Louis, MO:
Mosby.
3. Potter, P.A. & Perry; A.G. (2005). Fundamentals of nursing: Concepts, process, and practice
(6th ed.). St. Louis, MO: Mosby. (pp.1117-1121 ).
4.
VT #204: Chest tube drainage.
5.
CD #CD021: Care of chest tubes
Independent Learning Activities
Learning Outcomes
1. State the purpose of closed chest drainage.
2. Briefly describe three conditions that would require closed chest drainage.
3. Identify each chamber in a closed chest drainage system.
4. Describe the function of each chamber in a closed chest drainage system.
5. Distinguish between “wet” suction and “dry” suction in a closed chest drainage system
6. Identify common assessment findings in a client needing a chest tube.
7. Place the steps of a chest tube insertion in the proper order.
8. List equipment that should be at the bedside of a client with a chest tube.
9. Select nursing actions appropriate to the care of a client with closed chest drainage.
N155: Closed chest drainage KEY
2
Learning Activities
1. What is the purpose of closed chest drainage?
The purpose of chest tubes is to remove air and fluid from the pleural space and to restore
normal intrapleural pressure so that the lung(s) can re-expand.
2. Briefly describe three conditions that would require closed chest drainage.
A chest tube would be needed in circumstances when intrapleural pressure becomes equal
to atmospheric pressure.
a. chest trauma (gunshot wound, fractured rib)
b. thoracotomy
c. spontaneous pneumothorax
3. Label each chamber in the diagram of the closed chest drainage system.
Drainage
collection
chamber
Water seal
chamber
N155: Closed chest drainage KEY
Suction
regulator
Suction
control
chamber
3
4. Describe the function of each chamber in a closed chest drainage system.
a. Water seal
The water seal chamber acts as a one-way valve to prevent air from re-entering the
pleural space. Air is expelled from the pleural cavity and bubbles up through the water
seal chamber, but the water prevents the air from returning to the pleural space.
b. Drainage collection
The drainage collection chamber collects fluid drainage from the pleural space. Fluid
remains in this chamber while air from the pleural space vents to the water seal chamber.
The drainage collection chamber has markings so that the amount of fluid drained can be
measured.
c. Suction control
The suction control chamber controls the degree of negative pressure applied to the
pleural space.
5. What is the difference between a “wet” suction and “dry” suction closed chest drainage
system? Describe each briefly.
a. Wet suction
Wet suction is the classic type of suction control described in the previous question. To
set it, fill the chamber with sterile water to the level ordered by the physician, usually 1020 cm water pressure. Then turn up the vacuum source until gentle bubbling is noted in
the suction control chamber. The degree of negative pressure applied to the pleural space
is determined by how much water is in the suction control chamber, not by the level of
suction at the vacuum source. To determine if the suction is working, simply look at the
suction control chamber: if the chamber is bubbling gently, the suction is working.
b. Dry suction
Dry suction uses no water, but instead uses either a restrictive device or a regulator to
dial the desired negative pressure, which is internal in the system. The dry system has a
visual alert that indicates if the suction is working.
6. Your client needs to have a chest tube placed. Circle the assessment findings you would
expect to see in this client.
relaxed, even
breathing
decreasing oxygen
saturation
shortness of breath
agitation
increased respiratory rate
pink nail beds and lips
decreased
respiratory rate
decreased breath sounds on
one side
chest pain
N155: Closed chest drainage KEY
4
7. Your post-surgical client has developed a hemothorax and you are now preparing to assist
with chest tube insertion. Place the following steps in the proper order.
___5__ attach drainage tube to chest tube
___3__ position the client so that the tube site will be accessible to the physician
___6__ adjust tubing to hang in a straight line from the top of the mattress to the
drainage chamber
___1__ set up the chest tube system and place at the bedside
___4__ assist physician by providing needed equipment, analgesic, and offering support
and instruction
___2__ check patency of air vents in system
8.
After insertion, what will you want to tape to the top of the client’s bed?
A set of clamps with rubber protection should be available for changing the drainage
system, assessment before removal of the chest tube, or in an emergency if the drainage
tube becomes disconnected. Some agencies also put a container of sterile water at the
bedside to act as an emergency water seal in the event the tube becomes disconnected.
9. Nursing care of the client with closed chest drainage can be complex. Following is a list of
potential nursing care actions. Check the items that are appropriate for the care of a client
with closed chest drainage.
X Keep all tubing as straight as possible and coiled loosely on the bed; don’t let client lie
on the tubing.
X Tape all connections to keep them tight and prevent leaking of air or fluid.
___Vigorously strip the tubing every hour.
___Periodically disconnect the tubing from water seal.
X Add sterile water to suction control and water seal chambers prn to keep water at the
appropriate levels.
X Check for bubbling in the water seal chamber.
___Check for bubbling in the drainage chamber.
X Monitor the client’s clinical status: check vital signs, auscultate lungs, measure oxygen
saturation, observe for unequal chest wall movement.
X Never elevate drainage system to level of client’s chest
X Encourage client to breathe deeply periodically to facilitate lung expansion.
N155: Closed chest drainage KEY
5
___Always keep the drainage system at the client’s heart level.
X Check position of the drainage system; keep it upright so that the water seal and the
drainage chambers are not disrupted.
X Mark time of measurement and fluid level according to physician order.
10. Your client was diagnosed with a pneumothorax and had a chest tube placed 1 hour ago. You
notice there is intermittent bubbling in the water seal chamber. Is this a cause for concern?
This would be an expected finding for this client.
Why or why not?
The intermittent bubbling indicates an air leak, that is air is being expelled from the pleural
space via the drainage tubing and through the water seal chamber. This finding would be
expected in a client with a newly inserted chest tube for pneumothorax.
11. If you observe continuous bubbling in this client’s water seal chamber, what does this mean?
Continuous bubbling indicates either a large intrapleural air leak, or an air leak somewhere
in the drainage tubing between the client and the collection chamber.
12. Your client has had a chest tube in for 72 hours. If no fluctuations are observed in the water
seal chamber, what does this mean?
If there are no fluctuations, it means that either the drainage system is kinked or
obstructed, or the lung(s) have re-expanded. At 72 hours, it is most likely that the lungs
have re-expanded.
N155: Closed chest drainage KEY