Managing A Chest Tube and Drainage System: Rajaraman Durai, Happy Hoque, Tony W. Davies

Managing a Chest Tube and
Drainage System
RAJARAMAN DURAI, MD, MRCS; HAPPY HOQUE, FRCS; TONY W. DAVIES, FRCS 1.3
ABSTRACT
Intercostal drainage tubes (ie, chest tubes) are inserted to drain the pleural cavity of air,
blood, pus, or lymph. The water-seal container connected to the chest tube allows
one-way movement of air and liquid from the pleural cavity. The container should not
be changed unless it is full, and the chest tube should not be clamped unnecessarily. After
a chest tube is inserted, a nurse trained in chest-tube management is responsible for
managing the chest tube and drainage system. This entails monitoring the chest-tube
position, controlling fluid evacuation, identifying when to change or empty the contain-
ers, and caring for the tube and drainage system during patient transport. This article
provides an overview of indications, insertion techniques, and management of chest
tubes. AORN J 91 (February 2010) 275-280. © AORN, Inc, 2010
Key words: intercostal drainage tube, chest tube, water-seal drainage, pneumo-
thorax, hemothorax, pyothorax, chylothorax, pleural effusion.
A
70-year-old woman was admitted to the water-seal chamber was completely empty. A nurse
hospital with breathing difficulty six weeks had mistakenly emptied the entire chest-tube con-
after undergoing a gastrectomy for stomach tainer to measure daily output, which is not an indi-
cancer. The physician ordered a chest x-ray, which cation for emptying a chest-tube-drainage container.
showed a pleural effusion (ie, excess fluid in the Furthermore, the nurse did not then refill the water-
pleural cavity) (Figure 1). The physician inserted an seal chamber. The surgeon immediately placed a
intercostal drainage tube (ie, chest tube) to drain the clamp on the chest tube while the water seal was
pleural effusion and attached the tube to an under- reinstituted. A chest x-ray was taken and indicated
water seal so that air could not enter the pleural cav- that a pneumothorax had not occurred. The surgeon
ity. On the following day, when the surgical team completed a critical incident report. The nurse re-
assessed the patient, the surgeon noted that the sponsible for emptying the chest-tube container ad-
mitted to not knowing how to formally manage
indicates that continuing education contact chest tubes.
hours are available for this activity. Earn the con- A variety of drains are used in surgical practice;
tact hours by reading this article, reviewing the however, management of these drains is not the
purpose/goal and objectives, and completing the same. Closed-suction drains with a vacuum con-
online examination and learner evaluation at http://
tainer draw fluid from the wound. Their containers
www.aornjournal.org/ce. The contact hours for this
are replaced when they are full or when there is a
article expire February 28, 2013.
loss of vacuum. A chest tube and its water-seal
© AORN, Inc, 2010 February 2010 Vol 91 No 2 ● AORN Journal 275

Downloaded for Fakultas Kedokteran Universitas Sam Ratulangi ([email protected]) at Sam Ratulangi University from
ClinicalKey.com by Elsevier on May 19, 2022. For personal use only. No other uses without permission. Copyright ©2022. Elsevier Inc. All rights
reserved.
February 2010 Vol 91 No 2 DURAI—HOQUE—DAVIES
fect or the chest tube is larger than the size of the

trachea.
Whenever the pleural cavity is drained by a chest
tube, whether it is for blood, air, pus, or lymph, the
tube should be connected to a water-seal drainage
container so that air is not inadvertently sucked into
the chest. The water-seal drainage container nor-
mally is filled with approximately 375 mL of sterile
water to the marked level.
In years past, a series of up to three reusable
glass bottles were connected to one another and at-
tached to the chest tube. Currently, clear plastic dis-
posable containers are used instead. They consist of
either a single chamber with an underwater seal
Figure 1. Chest x-ray, showing a pleural effusion on (Figure 2) or a three-chamber container with a
the left side. collection chamber,
container, which is a closed drainage system, re- suction chamber, and
quires a different approach. The water-seal chamber water-seal chamber in the middle (Figure 3).
allows only one-way movement: air and liquid can Chest tubes inserted for treating pneumothorax
escape from the pleural cavity but cannot flow in should not be clamped except for the briefest time
the reverse direction. Managing a chest tube requires possible when the container is being changed or the
monitoring the chest-tube position and controlling amount of drainage of a pleural effusion needs to be
fluid evacuation. The water-seal chamber should not controlled to prevent re-expansion pulmonary ede-
be emptied unless the drainage container is full. ma.8 Re-expansion pulmonary edema occurs when a
Some health care facilities allow trained nurses to collapsed lung expands rapidly, causing capillary
remove chest tubes1 but not all nurses are familiar damage that results in unilateral pulmonary edema.
with this procedure,2 and there is not sufficient pub- A specific care pathway for chest-tube insertion and
lished research describing the nursing management management may be useful.9
of chest tubes.3 This article provides information for
nurses about chest tubes and their management.
INDICATIONS FOR A CHEST TUBE

The potential space around the lungs is called the
pleural cavity. Under normal conditions, the pleural
cavity is maintained by negative pressure, which is
important for ensuring lung expansion with deep
inspiration. When blood (ie, hemothorax),4 air (ie,
pneumothorax),5 pus (ie, pyothorax),6 or lymph (ie,
chylothorax)7 collects in the pleural cavity, negative
pressure is lost and lung expansion is restricted. The
chest-tube drain allows fluid or air to drain from the
pleural cavity. As a result of the negative pressure,
however, the air may preferentially enter the pleural Figure 2. A single-chamber chest-tube drainage
cavity, particularly if the size of the chest-wall de- container with markings for a basic underwater seal.
276 AORN Journal

reserved.
MANAGING A CHEST TUBE AND DRAINAGE SYSTEM www.aornjournal.org
with a lot of pleural fluid, the posterior axillary line

may be chosen at the seventh or eighth intercostal
space. It is relatively safe to insert the tube at a
lower space because the large amount of fluid dis-
places the diaphragm away. Current UK National
Patient Safety Agency (NPSA) alert guidelines sug-
gest that inserting chest tubes under ultrasound guid-
ance decreases the risk of complications.12
Before chest-tube insertion, the nurse prepares a
sterile table with a scalpel, local anesthetic, thick
silk or a polypropylene suture on a cutting needle, a
chest tube of an appropriate size, and the underwater
seal with sterile water filled to the mark. There are
Figure 3. A three-chamber chest-tube drainage
container system. two methods for inserting a chest tube. The first one
is trocar based (ie, the Seldinger technique). The
CHEST TUBE INSERTION second is a blunt-dissection method by using a fin-
A variety of clinicians, such as surgeons, physicians, ger and an arterial forceps.
advance practice nurses (eg, nurse practitioners), and The trocar method allows for easier insertion but
physician assistants, may insert chest tubes. The creates the risk of lacerating the lung from overpen-
correct method of inserting a chest tube and appro- etration. In the trocar method, the clinician incises
priate aftercare may shorten the patient’s duration of the skin and inserts a trocar with a surrounding
hospitalization.10 chest tube in a controlled manner until reaching the
Typically, a single chest tube is inserted. To drain pleura. The clinician then removes the trocar and
blood, pus, or lymph from the pleural cavity, the leaves the chest tube in place.
chest tube is inserted at a slightly lower intercostal Blunt dissection may cause more discomfort to
space (eg, sixth or seventh). To drain air from the the patient, but it creates less risk for damaging vital
pleural cavity, the chest tube may be inserted at a structures. In this method, the clinician incises the
higher intercostal space (eg, second). Sometimes, patient’s skin and splits (ie, separates) the intercostal
however, two tubes are inserted: one at a lower in- muscles with a finger and a blunt arterial forceps
tercostal space to drain blood or pus and another at until reaching the pleural cavity. The clinician then
a higher intercostal space to resolve a pneumothorax. holds the tip of the chest tube with the artery for-
After cleansing the patient’s skin, the clinician ceps and introduces the tube into the pleural cavity.
infiltrates the patient’s skin and chest wall with local Best practice is to use a “mattress” suture or a
anesthetic. A common site of insertion, the “safe “stay-in closure” suture to secure the chest tube.8,13
triangle,”11 is framed by the anterior border of the To do this, the clinician places an extra, loose mat-
latissimus dorsi, the lateral border of the pectoralis tress stitch when stitching the chest tube in place.
major muscle, and a line superior to the horizontal Purse-string sutures are not recommended because
level of the nipple and an apex below the axilla. In they cause pain by changing a linear wound into a
this space, the likelihood of damaging any vital circular one and can leave unsightly scars.
structure during insertion is very low. The dia- A dummy model for practicing chest-tube inser-
phragm can rise to the fifth rib at the nipple level tion is commercially available.14 A new type of for-
during expiration, and, thus, chest tubes should be ceps also is available for chest-tube insertion when
placed above this level to avoid inadvertently dam- using the blunt-dissection method, and one source
aging abdominal structures. For a large hemothorax claims that no complications have resulted from use
AORN Journal 277

reserved.
of this forceps.15 The most common error commit- water is changed and ensure that the water-seal
ted by junior clinicians when inserting a chest tube chamber is refilled to the marked level.
is to place the tube too low.16
Controlling Fluid Evacuation
The nurse should alert the surgeon if the chest-tube
HOW TO MANAGE A CHEST TUBE AND
DRAINAGE SYSTEM drains more than 250 mL of bloody drainage in an
After a chest tube has been inserted, a nurse trained hour or if a total of more than 500 mL is drained.
in chest-tube management is responsible for manag- Excessive blood loss may indicate that the patient
ing the chest tube and drainage system. This entails requires a thoracotomy to repair any underlying
caring for the tube and drainage system when trans- damaged blood vessel. Another concern when con-
porting the patient, changing or emptying the drain- trolling fluid evacuation is re-expansion pulmonary
age container, controlling fluid evacuation, being edema, which may occur after rapid evacuation of
able to identify a bronchopleural fistula, and moni- large pleural effusions or in association with sponta-
toring chest-tube position. neous pneumothorax. Anecdotal evidence suggests
that the tube be clamped for one hour after 1 L of
Caring for the Chest Tube and Drainage drainage. Although there is no published evidence
System During Transport for actual amounts, good practice suggests that, de-
Nurses should facilitate transport of a patient with a pending on the patient’s hemodynamic status,
chest tube without clamping the tube and should
no more than 1.5 L should be drained at any
ensure that the container remains upright and at-
one time or,
tached safely to the bedside while also monitoring
no more than 1.5 L should be drained during a
the drainage container.13 The nurse should ensure
24-hour period, or
that the water-seal drainage container remains below
drainage should be slowed to approximately
the chest-tube insertion site while transporting the
500 mL per hour.8,13
patient; otherwise, the contents of the container can
backflow into the pleural cavity.13 If clamping a Identifying a Bronchopleural Fistula
chest tube for transport is unavoidable (eg, it is not If bubbling occurs in the water-seal chamber, then
possible to keep the drainage container below the the patient may have a bronchopleural fistula. In this
level of the chest), then a nurse trained in chest-tube situation, the chest tube should not be clamped be-
management should monitor the patient for signs of cause clamping the tube can cause a tension pneu-
deterioration in oxygen saturation or respiratory mothorax, which can be lethal.
rate or an increase in respiratory distress and should
unclamp the tube when the patient reaches the Monitoring Chest-tube Position
destination.17 Good nursing care is needed because the chest tube
can migrate.18 A postoperative chest radiograph is
Changing or Emptying the Drainage required to confirm the chest-tube position. If the
Container chest tube is in the correct position, then the water
There are only two indications for changing or emp- column in the water-seal chamber moves during
tying the container. The container is replaced when respirations. The column will not move when the
the fluid is turbid (ie, cloudy or muddy in appear- lung is fully expanded.
ance, with matter in suspension) or the container is
full. The water-seal chamber itself should not be HOW TO REMOVE THE CHEST TUBE
emptied unless the drainage container is full. If the When the chest tube is removed, the lungs should
drainage container needs to be changed or emptied, be fully expanded, which minimizes the pleural
then the nurse must clamp the chest tube while the space. This can only be achieved when the patient
278 AORN Journal

reserved.
MANAGING A CHEST TUBE AND DRAINAGE SYSTEM www.aornjournal.org
holds his or her breath while performing the Val- note the site of local anesthetic infiltration so
salva maneuver (ie, trying to exhale against a that the tube is inserted into the anesthetized
closed glottis or bearing down) or at the end of skin. Alternatively, the clinician can mark the
expiration.8,13 patient’s skin with a skin marker at the site of
Chest-tube removal can be very painful for the infiltration.
patient and requires appropriate analgesia.19 After Bleeding—Intercostal arteries may bleed pro-
administering analgesia, the clinician cuts the hold- fusely when traumatized. Similarly, lacerated
ing stitch and removes the chest tube. He or she lung parenchyma also can bleed, but the bleed-
immediately tightens the mattress stitch to close the ing normally stops without any intervention
tract between the pleura and the atmosphere. Within when the lung expands.
a few days, the hole in the deeper layers of the Occlusion—Small chest tubes can become
chest wall will be closed by fibrous tissue. Often, a blocked by blood clot and fibrin.22 Occlusion
chest x-ray is taken after removal of a chest tube. may be serious and can lead to a repeated pneu-
Recent evidence indicates that a chest x-ray is re- mothorax. Clinicians should inspect the tubing
quired only if the patient develops clinical symptoms regularly and change it as needed if it becomes
that suggest the original problem has reoccurred.20 occluded. “Milking” or “stripping” an occluded
chest tube is no longer recommended because it
COMPLICATIONS OF CHEST-TUBE USE increases the negative pressure in the intratho-
Numerous complications may occur when a chest racic cavity, which could damage lung tissue.13
tube is in place. These complications include the Serious harm and death—Although it is a minor
following: procedure, 12 deaths and 15 incidences of seri-
Dislodging the chest tube—Smaller chest tubes ous body harm related to chest tubes were re-
can fall out if they are not properly secured. In ported to the NPSA between January 2005 and
such cases, a sterile occlusive dressing with a March 2008.12 Eight of the incident reports were
one-way valve may be useful for treating an related to the Seldinger insertion technique
open pneumothorax from a penetrating chest alone. Some causes of serious complications of
trauma.21 This unique, one-way valve lets air chest-tube insertion include
and blood escape but does not allow anything to anatomical abnormality,
enter from the outside. too-deep dilation,
Damage to the diaphragm—On occasion, a chest failure to consider patient’s condition,
tube may be inserted too low. If this occurs, then failure to follow facility policy or
the diaphragm may be damaged. procedure,
Injury to internal organs—According to the failure to follow manufacturer’s advice,
NPSA, the lungs, liver, and spleen can be in- lack of knowledge,
jured during chest-tube insertion.12 For instance, poor imaging quality, and
12
if the chest tube is inserted below the diaphragm poor technique.
into the abdomen, then the risk of injuring inter-
nal organs is increased. When the tube is pushed SUMMARY FOR MANAGING A CHEST
in too far, there is even a possibility of punctur- TUBE AND DRAINAGE SYSTEM
ing the heart. Chest tubes are inserted to drain the pleural cavity
Pain—The parietal pleura is very sensitive; of air, blood, pus, or lymph. An underwater seal
therefore, the patient will experience pain unless should be maintained at all times, and the chest-
adequate anesthetic medication is administered. tube-drainage container should not be emptied
While inserting a chest tube, the clinician should unnecessarily. During transport, the chest-tube
AORN Journal 279

reserved.
container should be maintained below the level of 15. Andrews E, Ramesh BC, Nölke L, Redmond HP,
Aherne T, O’Donnell A. A new specifically designed
the patient’s chest and clamping of the chest tube forceps for chest drain insertion. Injury. 2003;34(12):
should be avoided. Chest-tube insertion can cause 957-959.
complications, such as bleeding, pain, damage to 16. Griffiths JR, Roberts N. Do junior doctors know where
to insert chest drains safely? Postgrad Med J. 2005;
internal organs, and at times, death. All nurses who 81(957):456-458.
care for patients with chest tubes should be knowl- 17. Henry M, Arnold T, Harvey J; Pleural Diseases Group,
Standards of Care Committee, British Thoracic Society.
edgeable about managing chest tubes. BTS guidelines for the management of spontaneous
pneumothorax. Thorax. 2003;58(Suppl 2):ii39-ii52.
References 18. Gossage JA, Chukwuemeka AO, Dussek JE. Intercostal
1. Christensen M. Nurse-led chest drain removal in a car- drain migration post esophagectomy. Dis Esophagus.
diac high dependency unit. Nurs Crit Care. 2002;7(2): 2003;16(3):268-269.
67-72. 19. Bruce EA, Howard RF, Franck LS. Chest drain re-
2. Lehwaldt D, Timmins F. Nurses’ knowledge of chest moval pain and its management: a literature review.
drain care: an exploratory descriptive survey. Nurs Crit J Clin Nurs. 2006;15(2):145-154.
Care. 2005;10(4):192-200. 20. van den Boom J, Battin M. Chest radiographs after re-
3. Charnock Y, Evans D. Nursing management of chest moval of chest drains in neonates: clinical benefit or
drains: a systematic review. Aust Crit Care. 2001;14(4): common practice? Arch Dis Child Fetal Neonatal Ed.
156-160. 2007;92:F46-F48.
4. Jacoby RC, Battistella FD. Hemothorax. Semin Respir 21. Rathinam S, Steyn RS. Management of complicated
Crit Care Med. 2001;22(6):627-630. postoperative air-leak: a new indication for the Asher-
5. Kang SN. Rib fractures, pneumothorax, haemothorax man chest seal. Interact Cardiovasc Thorac Surg. 2007;
and chest drain insertion. Br J Hosp Med (Lond). 2007; 6(6):691-694.
68(9):M158-M159. 22. Davies HE, Merchant S, McGown A. A study of the
6. Klopp M, Pfannschmidt J, Dienemann H. Treatment of complications of small bore “Seldinger” intercostal
pleural empyema [in German]. Chirurg. 2008;79(1):83-96. chest drains. Respirology. 2008;13(4):603-607.
7. Townshend AP, Speake W, Brooks A. Chylothorax.
Emerg Med J. 2007;24(2):e11.
8. Laws D, Neville E, Duffy J; Pleural Diseases Group,
Standards of Care Committee, British Thoracic Society. Rajaraman Durai, MD, MRCS, is a specialist
BTS guidelines for the insertion of a chest drain. Tho- registrar at University Hospital Lewisham, Lon-
rax. 2003;58(Suppl 2):ii8-ii17.
don, UK. Dr Durai has no declared affiliation
9. Medford AR, Pepperell JC. Management of spontane-
ous pneumothorax compared to British Thoracic Soci- that could be perceived as a potential conflict of
ety (BTS) 2003 guidelines: a district general hospital interest in publishing this article.
audit. Prim Care Respir J. 2007;16(5):291-298.
10. Dordeviæ I, Staniæ V, Nestoroviæ M, Vuloviæ T. Fail- Happy Hoque, FRCS, is a consultant surgeon
ures and complications of thoracic drainage [in Serbian].
Vojnosanit Pregl. 2006;63(2):137-142.
with the Department of Surgery at Queen Mary’s
11. Ellis H. The applied anatomy of chest drain insertion. Hospital, Sidcup, Kent, UK. Dr Hoque has no
Br J Hosp Med (Lond). 2007;68(3):M44-M45. declared affiliation that could be perceived as a
12. Chest drains: risks associated with the insertion of chest
drains. May 1, 2008. National Patient Safety Agency. potential conflict of interest in publishing this
National Report and Learning Service. http://www.nrls. article.
npsa.nhs.uk/resources/?entryid45⫽59887. Accessed No-
vember 7, 2009. Tony W. Davies, FRCS, is a consultant surgeon
13. Roskelly L. Intrapleural drainage. In: Doughtery L,
Lister S, eds. The Royal Marsden Hospital Manual of
with the Department of Surgery at Queen Mary’s
Clinical Nursing Procedures. 7th ed. Hoboken, NJ: Hospital, Sidcup, Kent, UK. Dr Davies has no
Wiley-Blackwell; 2008:428-433. declared affiliation that could be perceived as a
14. Hutton IA, Kenealy H, Wong C. Using simulation
models to teach junior doctors how to insert chest potential conflict of interest in publishing this
tubes: a brief and effective teaching module. Intern article.
Med J. 2008;38(12):887-891.
280 AORN Journal

reserved.
EXAMINATION
CONTINUING EDUCATION PROGRAM
1.3
Managing a Chest Tube and Drainage
System
PURPOSE
To educate perioperative nurses about managing a chest tube and drainage system.
OBJECTIVES
1. Explain the physiology of the respiratory system.
2. Discuss the pathophysiology of the respiratory system.
3. Describe a chest-tube drainage system.
4. Explain medical care of a patient who requires a chest tube.
5. Identify nursing responsibilities in caring for a patient with a chest tube.
The Examination and Learner Evaluation are printed here for your convenience. To
receive continuing education credit, you must complete the Examination and
Learner Evaluation online at http://www.aorn.org/CE.
QUESTIONS capillary damage that results in unilateral pulmo-

1. A chest-tube drainage system nary edema.
1. has a water-seal chamber. a. true b. false
2. allows only one-way movement or air or
liquid. 4. The chest tube is inserted at a lower intercostal
3. allows air and liquid to escape from the pleu- space when _____________ is being drained
ral cavity. from the pleural cavity.
4. allows air to enter the pleural cavity to rein- 1. air
flate the lung. 2. blood
a. 1 and 3 b. 2 and 4 3. lymph
c. 1, 2, and 3 d. 1, 2, 3, and 4 4. pus
a. 1 and 3 b. 2 and 4
c. 2, 3, and 4 d. 1, 2, 3, and 4
2. The pleural cavity is maintained by ____________
pressure, which is important for ensuring lung ex-
pansion with deep inspiration. 5. To prepare for chest-tube insertion, the nurse pre-
a. negative b. positive pares a sterile table with
1. a chest tube of an appropriate size.
2. a scalpel.
3. Re-expansion pulmonary edema occurs when a 3. a water-seal drainage system with sterile water
collapsed lung expands rapidly and causes filled to the mark.

reserved.
February 2010 Vol 91 No 2 CE EXAMINATION
4. local anesthetic. tion in oxygen saturation or respiratory rate or

5. thick silk or a polypropylene suture on a cut- an increase in respiratory distress.
ting needle. a. 2 and 3 b. 1, 4, and 5
a. 2 and 3 b. 1, 4, and 5 c. 2, 3, 4, and 5 d. 1, 2, 3, 4, and 5
c. 2, 3, 4, and 5 d. 1, 2, 3, 4, and 5
8. The water-seal chamber should not be emptied
unless the drainage container is full.
6. Compared with the Seldinger technique, the blunt
a. true b. false
dissection method
1. allows for easier insertion.
9. During chest-tube removal, the patient is in-
2. may cause more discomfort to the patient.
structed to
3. presents an increased risk of lacerating the
a. cough and deep breathe.
lung from overpenetration.
b. hold his or her breath while performing the
4. creates less risk for damaging vital structures.
Valsalva maneuver.
a. 1 and 3 b. 2 and 4
c. take shallow panting breaths.
c. 1, 2, and 3 d. 1, 2, and 4
10. Complications that may occur when a chest tube
7. A nurse’s responsibility during transport of a pa- is in place include
tient with a chest tube includes 1. bleeding.
1. ensuring that the chest tube is always clamped 2. damage to the diaphragm or other internal
during transport. organs.
2. ensuring that the container remains upright and 3. dislodging of the chest tube.
is attached safely to the bedside. 4. occlusion.
3. ensuring that the water-seal drainage container 5. pain.
remains below the chest-tube insertion site. 6. serious harm or death.
4. monitoring the drainage container. a. 1, 3, and 5 b. 2, 4, and 6
5. monitoring the patient for signs of deteriora- c. 2, 3, 4, 5, and 6 d. 1, 2, 3, 4, 5, and 6
The behavioral objectives and examination for this program were prepared by Rebecca Holm, RN, MSN, CNOR, clinical editor,
with consultation from Susan Bakewell, RN, MS, BC, director, Center for Perioperative Education. Ms Holm and Ms Bakewell
have no declared affiliations that could be perceived as potential conflicts of interest in publishing this article.
282 AORN Journal

reserved.
LEARNER EVALUATION
CONTINUING EDUCATION PROGRAM
1.3
Managing a Chest Tube and Drainage
System
T
his evaluation is used to determine the extent to 9. Will you change your practice as a result of
which this continuing education program met reading this article? (If yes, answer question
your learning needs. Rate the items as described #9A. If no, answer question #9B.)
below. 9A. How will you change your practice (Select all
that apply)
1. I will provide education to my team regarding
OBJECTIVES why change is needed.
To what extent were the following objectives of this 2. I will work with management to change
continuing education program achieved? and/or implement a policy and procedure.
1. Explain the physiology of the respiratory 3. I will plan an informational meeting with phy-
system. Low 1. 2. 3. 4. 5. High sicians to seek their input and acceptance of
2. Discuss the pathophysiology of the respiratory the need for change.
system. Low 1. 2. 3. 4. 5. High 4. I will implement change and evaluate the ef-
3. Describe a chest-tube drainage system. fect of the change at regular intervals until the
Low 1. 2. 3. 4. 5. High change is incorporated as best practice.
4. Explain medical care of a patient who requires a 5. Other:
chest tube. Low 1. 2. 3. 4. 5. High
9B. If you will not change your practice as a result
5. Identify nursing responsibilities in caring for a
of reading this article, why? (Select all that
patient with a chest tube.
apply)
Low 1. 2. 3. 4. 5. High
1. The content of the article is not relevant to my
practice.
2. I do not have enough time to teach others
CONTENT
about the purpose of the needed change.
6. To what extent did this article increase your 3. I do not have management support to make a
knowledge of the subject matter? change.
Low 1. 2. 3. 4. 5. High 4. Other:
7. To what extent were your individual objectives
met? Low 1. 2. 3. 4. 5. High 10. Our accrediting body requires that we verify the
8. Will you be able to use the information from this time you needed to complete the 1.3 continuing
article in your work setting? 1. Yes 2. No education contact hour (78-minute) program:
This program meets criteria for CNOR and CRNFA recertification, as well as other continuing education requirements.
AORN is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.
AORN recognizes these activities as continuing education for registered nurses. This recognition does not imply that AORN or the American Nurses Credentialing Center
approves or endorses products mentioned in the activity.
AORN is provider-approved by the California Board of Registered Nursing, Provider Number CEP 13019. Check with your state board of nursing for acceptance of this
activity for relicensure.
Event: #10006; Session: #9943 Fee: Members $6.50, Nonmenbers $13

The deadline for this program is February 28, 2013.
A score of 70% correct on the examination is required for credit. Participants receive feedback on incorrect answers. Each
applicant who successfully completes this program will be able to print a certificate of completion.

reserved.

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Managing a Chest Tube and

© AORN, Inc, 2010 February 2010 Vol 91 No 2 ● AORN Journal 275

fect or the chest tube is larger than the size of the

INDICATIONS FOR A CHEST TUBE

276 AORN Journal

with a lot of pleural fluid, the posterior axillary line

AORN Journal 277

278 AORN Journal

AORN Journal 279

280 AORN Journal

QUESTIONS capillary damage that results in unilateral pulmo-

© AORN, Inc, 2010 February 2010 Vol 91 No 2 ● AORN Journal 281

4. local anesthetic. tion in oxygen saturation or respiratory rate or

282 AORN Journal

Event: #10006; Session: #9943 Fee: Members $6.50, Nonmenbers $13

© AORN, Inc, 2010 February 2010 Vol 91 No 2 ● AORN Journal 283

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