Skill 39[1]..Assisting with Chest Tube Insertion.pdf

SKILL 39

Assisting with Chest Tube Insertion

4 gauze

Medicine cup

Y connector

Forceps

Drapes, towels

Sterile water or saline (1,000 cc bottle)

Local anesthetic

Gloves, sterile

Gown, mask

Stethoscope

Antiseptic (e.g., povidone-iodine)

Alcohol swabs

Petrolatum gauze

Clamp, padded

Adhesive tape

Rubber band and safety pin (optional)

Suture with needle (check if in tray)

b. Check the water seal for bubbles. Bubbles in the

water seal chamber/bottle indicate air is entering the

system. Potential sources of air include (1) a leak in

the tubing, (2) a leak under the dressing, (3) a leak

from the pleural cavity, (4) drainage of air from the

pleural cavity, and (5) a crack in the unit.

c. Make sure all tubing connections are tight and

wrapped with adhesive tape. Loose connections will

cause an air leak in the system and ineffective

drainage of fluid and air.

d. Secure chest tube drainage tube to gown using the

clamp that comes with the system or a rubber band

and safety pin.

NOTE: Do not pin or secure tubing to the bedding.

Reduces the risk of accidentally dislodging the tube.

NOTE: Policy at some agencies may prohibit the use of

safety pins.

9. Assist in obtaining a chest X ray. Confirms position of

the tube and whether it has begun to evacuate fluid and

air.

10. Monitor vital signs, drainage, and insertion site every 15

minutes for 2 hours or according to agency policy.

DOCUMENTATION

1. Premedication given.

2. Insertion and how tolerated.

3. Size and location of tube.

4. Type of drainage system used.

5. X-ray results.

6. Functioning of drainage system, including if there is

suction and at what pressure.

7. Amount, color, and consistency of drainage.

8. Respiratory status.

PROCEDURE

1. Explain procedure and reason to child and family.

Enhances cooperation and participation and reduces

anxiety and fear.

2. Obtain signed consent.

3. Premedicate as ordered. Decreases discomfort associ-

ated with chest tube insertion.

4. Gather equipment. Promotes organization and effi-

ciency.

5. Wash hands. Reduces transmission of microorganisms.

6. Assist physician in preparing child and necessary sup-

plies. Set up drainage system according to instructions

accompanying the system (see Preparing the Chest

Tube Drainage System).

7. Assist physician as required.

8. Once the tube is in place and connected to the drainage

system, ensure the integrity and functioning of the sys-

tem.

a. Ensure that the water in the suction control cham-

ber/bottles is bubbling gently.

EQUIPMENT

Chest tube tray (generally includes):

Chest tube (size designated by physician)

Trocar

Drainage system

Suture scissors

Hemostats

Needle holder

Syringes

Needles of various sizes

Stopcock

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