PROCEDURE

1. Assessment

a. Assess respiratory status every 2 hours or according

to agency policy.
1. Note rate, rhythm, depth, and ease of respira-

tions. Also note anxiety and chest discomfort.

2. Auscultate lungs and percuss lung fields. Check

for symmetry of chest movement. Assesses for
presence of air or fluid in pleural cavity, fluid in
the lungs, and tension pneumothorax.

3. Assess for fluid fluctuation (with respiration) in

the water seal chamber/bottle. Fluctuations indi-
cate changes in pressure in the pleural space,
which occur when child breathes and the lung has
not fully expanded.

b. Note amount and color of drainage from chest tube.

Mark the level at the beginning of each collection
and at the end of every shift.

NOTE: If the child is actively bleeding, assess drainage
frequently, every 10–15 minutes.

c. Check dressing at least once a shift to assure it is

clean, dry, and intact.

NOTE: Dressing should be covered with adhesive tape.
Change dressing in accordance with agency policy.
Inspect entry site for drainage, inflammation, or subcu-
taneous emphysema.

d. Assess child’s level of discomfort and medicate as

ordered. Manipulation of chest wall and insertion of
chest tube are painful.

e. Assess functioning and integrity of drainage system

every 2 hours or according to agency policy.
1. Check for appropriate level of water in water seal

and suction chambers/bottles and refill with ster-
ile water or saline as needed.

2. Check for appropriate setting of wall suction.
3. Assess for bubbling in water seal chamber/bottle.

Indicates air leak.

4. Check drainage tubing for kinks or obstructed

flow. There should be no dependent loops of tub-
ing or tubing laid horizontally on the bed. Kinks,
obstructions, and dependent loops interfere with
chest tube drainage.

5. Check all connections between tubing to be sure

they are tight and taped. Loose connections cause
air leaks and ineffective drainage.

6. Check that system is below level of child.

Facilitates drainage. (Figure 27)

2. Do not strip or “milk” tubing unless specifically ordered

by physician. Stripping creates hazardously high pres-
sure in the pleural cavity, which can damage lung tissue
and pleura.

3. Transporting the child with a chest tube.

a. Disconnect from wall suction but keep connected to

water seal. Prevents air from entering the pleural
space.

b. Do not clamp chest tube during transport. No fluid

or air can escape from pleural cavity when tube is
clamped and potential for tension pneumothorax is
increased.

c. Deep drainage system below level of chest and

upright. Facilitates drainage and maintains water
seal.

4. Have chest tube clamp at bedside to clamp off tube

a. If bubbling occurs in water seal chamber/bottle while

system is on suction.

90

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SKILL 41

SKILL 41

Care of the Child with a Chest Tube

FIGURE 27 Chest tube set-up.

continued

NOTE: To check for air leak place clamp at various
points moving from the chest to the drainage system.
Bubbling stops once clamp is placed between the air
leak and the water seal.

b. When changing the tube or replacing the drainage

system. Prevents air from entering the pleural cavity.

c. When drainage system is cracked. Prevents air from

entering the pleural cavity.

d. During chest tube removal. Prevents air from enter-

ing the pleural cavity.

DOCUMENTATION

1. Results of assessment of respiratory status.
2. Amount and color of chest tube drainage.
3. Condition of dressing.
4. Results of assessment of drainage system.

91

Copyright © 2007 by Thomson Delmar Learning, a division of Thomson Learning, Inc. All rights reserved.

SKILL 41

SKILL 41

Care of the Child with a Chest Tube

continued