Chest tubes are life-saving medical devices used to remove air, blood, or fluid from the pleural space — the area between the lung and chest wall. By doing so, they help the lung re-expand and restore normal negative pressure in the pleural cavity.
Understanding when they’re used, how they function, and the nursing care required is essential for safe and effective patient management.
Purpose of Chest Tubes
Indications
Chest tubes are inserted to treat:
- Pleural Effusion – Fluid in the pleural space
- Hemothorax – Blood in the pleural space
- Pneumothorax – Air in the pleural space
These conditions can collapse a lung by disrupting the normal vacuum-like negative pressure that keeps the lung expanded.
Mechanism of Action
The chest tube is inserted into the pleural space and connected to a closed one-way drainage system. This system sucks out air, fluid, or blood while preventing backflow into the chest.
Key Nursing Tip:
Keep the chest tube drainage system below the patient’s chest level to facilitate gravity drainage and prevent backflow.
Chest Tube Chambers Explained
Chest tube drainage systems usually have three chambers:
1. Suction Control Chamber
- Provides gentle, steady suction (continuous bubbling if using wet suction)
- Think: child sucking on a milkshake — gentle bubbling is ideal, not vigorous
- Excessive bubbling can indicate a problem
Water Seal Chamber & Air Leak Monitor
- Acts as a one-way valve, preventing air from re-entering the pleural space
- Tidaling (water level rise and fall with breathing) = Good sign (lung not fully re-expanded yet)
- Continuous bubbling = BAD → Air leak present (NCLEX Tip)
Memory Trick: Think of an ocean wave — gentle up-and-down movement = good.
Collection Chamber
- Collects drainage from the pleural space
- Normal drainage: Serosanguinous fluid (light pink)
- Bright red blood > 100 mL/hr after the first hour = Notify provider (possible hemorrhage)
- Dark bloody drainage = Normal if old blood
- Document all drainage type and amount
Patient Assessment with Chest Tubes
- Frequency: Every 2 hours
- Listen to lung sounds for changes
- Inspect dressing for infection or bleeding
- Check tubing for kinks or dependent loops
- Assess for subcutaneous emphysema (air trapped under skin, feels like Rice Krispies — "snap, crackle, pop")
If Drainage Stops or Decreases
- Auscultate lungs for diminished breath sounds (priority)
- Encourage patient to turn, cough, and deep breathe
- Reposition patient to promote drainage
Disconnection or Damage Management
If disconnected from the patient:
- Have patient cough and exhale immediately to prevent air entry
- Apply occlusive petroleum gauze dressing, secured on 3 sides (prevents tension pneumothorax)
If disconnected from the collection chamber:
- Place distal end into 250 mL sterile saline until a new system is connected
Chest Tube Removal
- Patient takes a deep breath, holds it, and bears down (Valsalva maneuver) while tube is removed
- Occlusive dressing applied immediately
Important Safety “No Nos”
- Never milk or strip the tubing (can cause high negative pressure and lung damage)
- Never allow continuous bubbling in the water seal chamber
- Never clamp during transport (risk of tension pneumothorax)
NCLEX & Exam Tips
- Dark blood: Document
- Bright red blood: Not normal, notify provider
- Continuous bubbling: Indicates air leak → troubleshoot immediately
- For pneumothorax: Keep drainage system below chest level (HESI Tip)
- For hemothorax: Assess respiratory status frequently (Kaplan Tip)
Summary Table – Chest Tube Nursing Care
| Aspect | Key Points |
|---|---|
| Purpose | Remove air/fluid, restore lung expansion |
| Position of System | Below chest level |
| Suction Control | Gentle bubbling |
| Water Seal | Tidaling = good; continuous bubbling = air leak |
| Collection Chamber | Monitor amount & color of drainage |
| Complications | Air leak, blockage, infection |
| Emergency Actions | Occlusive dressing for disconnection from patient; sterile saline if disconnected from chamber |
| Removal | Valsalva maneuver |
Frequently Asked Questions (FAQs)
Q1. Why secure the dressing on 3 sides for a chest tube disconnection?
To allow air to escape but prevent it from entering, reducing the risk of tension pneumothorax.
Q2. What does tidaling in the water seal chamber mean?
It means the lung has not fully re-expanded; this is expected in early recovery.
Q3. When should you notify the provider about chest tube drainage?
If bright red drainage > 100 mL/hr after the first hour, or sudden large increases in drainage.
Q4. Can patients with chest tubes ambulate?
Yes, if medically stable and the system is kept below chest level.
