Nursing Skills | Chest Tube Management

Chest tube management is a complex nursing skill used to maintain lung expansion, remove air or fluid from the pleural space, and support respiratory function. Nurses begin by assessing the insertion site for redness, swelling, drainage, or signs of infection. The dressing must remain clean, dry, and occlusive. The drainage system is kept below chest level to promote gravity drainage and prevent backflow. Nurses monitor the water seal chamber for tidaling, which reflects normal pleural pressure changes, and watch for continuous bubbling, which may indicate an air leak. The amount, color, and consistency of drainage are documented regularly. Sudden increases or bright red output may signal hemorrhage. Nurses also assess respiratory status, including breath sounds, oxygen saturation, and work of breathing. Clamping the tube is generally avoided unless ordered, as it can cause tension pneumothorax. Emergency supplies such as sterile water and clamps should be readily available. Documentation includes assessments, drainage measurements, and patient response.

Hints About Water Seal Function

Tidaling indicates normal pressure changes; continuous bubbling suggests air leak.

Tips About Site Assessment

Monitoring the insertion site prevents infection and complications.

Facts About Drainage Monitoring

Changes in output may indicate clinical deterioration.