Third Year Scenario: Chest Tube Management
Location: Emergency Department
History/Information:
This 24 year old male was brought to the Emergency Department via ambulance post
motor vehicle accident. The patient arrived 45 minutes prior to shift change. He was the
restrained driver and was T-boned on driver's side with deployment of the front airbag.
There were no other passengers in the car. The patient sustained right sided facial and
right upper extremity skin lacerations. The patient complained of muscle soreness to the
chest wall; no redness was noted. He is diaphoretic and in apparent respiratory distress.
There was no loss of consciousness in the field and he is awake and alert. The patient
denies any significant prior medical history. Chest x-ray confirmed a right pneumothorax.
The patient is anxious related to the accident and upcoming insertion of chest tube.
Healthcare Provider's Orders:
IV 0.9% NS at 125mL/hour
Oxygen 4LPM via nasal cannula
Cardiac monitor
Continuous SpO2
CBC, electrolytes, BUN, glucose, creatinine, PT, PTT STAT ECG STAT
Vital signs every hour
Complete bed rest
Chest tube to (-)20cm water suction
Learning Objectives:
1. Implements and evaluates a plan of care for the patient with a chest tube
(SYNTHESIS).
2. Outlines the possible causes of respiratory dysfunction with the patient with a ches1
tube (ANALYSIS).
3. Manages the nursing care of the patient with respiratory distress secondary to chest
tube dysfunction (APPLICATION).
Questions to Prepare for the Simulated Clinical Experience:
Please note that there is a chest tube powerpoint presentation on the 63-372
classnotes site under Pat McKay’s name that you can also use as a resource as well
as the readings, video & DVD that are assigned for the chest tube lab.
1. Discuss the rationale for why clamping of chest tubes is no longer advocated as
routine clinical practice.
2. What are 4 clinical manifestations of a pneumothorax?
3. Describe the pressure changes that occur intrapleurally with a pneumothorax.
4. What is the emergency management if a chest tube becomes disconnected?
5. Develop a teaching plan for the patient with a chest tube following
pneumothorax.
6. Describe the medical and nursing management of pneumothorax. Include a
discussion of symptomatology, diagnostic tests, and potential complications.
7. Identify the function of each of the components of the closed chest tube
drainage system.
8. What are the differences in characteristics of drainage when a chest tube is
inserted for a hemothorax, pneumothorax, or empyema?
9. What is the difference in placement location of a chest tube when inserted for a
hemothorax vs. pneumothorax?
10. What is the difference between the waterless chest drainage system & the pleurx
chest drainage system?
10. Outline routine care and maintenance of the chest tube system
11. Why is milking a chest tube not advocated as routine clinical practice?
12. What information can be obtained by asking a patient with a chest tube to cough?
References:
Baumann, M. H., and Strange, C. (2001). Management of spontaneous pneumothorax.
Chest, 119, 590-602.
Cohn, E. G., and Gilroy-Doohan, M. (2002). Flip and see ECG (2nd ed.).,philadelphia:
W. B. Saunders.
Jarvis, C. (2004). Physical examination and health assessment (4th ed.). St. Louis: W. B.
Saunders.
Joanna Briggs Institute for Evidence Based Nursing and Nurse Midwifery. (1999). Best
Practice Vital Signs, 3(3). Retrieved June 27, 2005, from
http://www.ioannabrigas.edu.au/
best practice/bp8.php
Lewis, S. M., Heitkemper, M. M., Dirksen, S. R., O'Brien, P. G., Giddens, J. F., and
Bucher, L. (2004). Medical-surgical nursing: Assessment and management of clinical
problems (6th ed.). St. Louis: Mosby.
McGee, S. (2001). Evidence-based physical diagnosis. Philadelphia: Saunders.
Pagana, K. D., and Pagana, T. J. (2006). Diagnostic and laboratory test reference (3rd
ed.). St. Louis: Mosby.
Potter, P. A., and Perry, A. G. (2005). Clinical nursing skills and techniques (5th ed.). St.
Louis: Mosby.
Potter, P. A., and Perry, A. G. (2005). Fundamentals of nursing (6th ed.). St. Louis:
Mosby.
Skidmore-Roth, L. (2005). Nursing drug reference. St. Louis: Mosby.
Springhouse. (2003). Best practices: A guide to excellence in nursing care. Philadelphia:
Lippincott Williams and Wilkins.