Chest tube care types and evidence-based nursing interventions

¶ … Chest Tubes

Nursing -- Chest Tubes

As the field of nursing gains more respect around the world, nursing professionals and nursing students becomes increasingly aware of the high degree of specialized knowledge and practice that are necessary to be a competent or successful nurse. One of the more complex tasks and pieces of equipment will be the focus of this paper, which is chest tubes. There are a few types of chest tubes including wet, dry, and those with Heimlich valves. Chest tubes are used for very specific and delicate types of injuries, mostly to the lungs.

Trauma, disease, or surgery can interrupt the closed negative-pressure system of the lungs, causing the lung to collapse. Air or fluid may leak into the pleural cavity. A chest tube is inserted and a closed chest drainage system is attached to promote drainage of air and fluid. Chest tubes are used after chest surgery and chest trauma and for pnuemothorax or hemothorax to promote lung re-expansion. (Medical Training.com, 2012)

Therefore, chest tubes are a significant trend or development within the field of nursing and patient care. Chest tubes serve vital functions to lung repair and continued bodily function. Chest tubes may be placed in the patient's chest while at a formal medical facility, but nurses who provide home care and care in residential facilities may put them to use in those environments as well. Thus it is critical that nursing students and professionals are up-to-date regarding the function of chest tubes, how to operate them, how to care for patients with them, as well understand literally how they work, in case of a situation that calls for sudden removal or repair. It is also vital for nurses to up to speed on chest tube care in the home as they may be a resource or expert that patients call upon when there is a question regarding usage and maintenance.

There is a great deal of equipment, technology, materials, and chemicals that nurses must be familiar with in order to be functional and competent at their positions. A chest tube is certainly in this category of specialized knowledge. Perhaps the first step in treating patients with chest tubes is to understand what a chest tube is for and what kinds of patients as well as what kinds of injuries necessitate their presence.

Chest Tube -- The purpose of a chest tube is to remove air or fluid that has entered the lung pleural space by surgical intervention (ex; thoracotomy, pericardial window, lung resection), specific disease processes (ex: pneumonia (causing empyema) asthma, carcinoma), or trauma (ex: penetrating injury, rib fracture, closed chest injury). The chest tube can function with or without suction allowing fluid to move upward on inhalation (which prevents air from entering the pleural space) and moving fluid downward on exhalation (which removes excess air or fluid into the chamber). The entry point of a chest tube is the fourth or fifth intercostal space, on the mid-axillary line, which is pretty close to the point at which you level a line transducer. The tube is inserted towards the collection, which is usually a high and anterior approach to collect air and a low and posterior approach to collect fluid. (Hudson, 2012)

As aforementioned, chest tubes are primarily used in the care or repair of injuries to the lungs. Chest tubes act as a sort of regulator in the chest when there is substantial injury. Their main purpose to make sure that the proper amount of air and fluid are in (and out) of the lungs. Lungs are clearly an extremely vital organ for any patient, thus immediately illustrating the need and the utility of such devices. Chest tubes must be inserted into the patient, sometimes through the mouth, but if surgery is involved, they may be place directly into the chest via the chest itself.

While hospitals, hospices, and other forms of formal institutions of formal care may be the best place for a patient with a condition requiring a chest tube, sometimes the stress from staying in a hospital or formal setting may hinder or inhibit the healing process. Therefore, there will be cases in a nurse's career when he/she will in a patient's home when the chest tubes are inserted and monitored. This is part of the full preparation to service and care for patients with chest tubes.

Chest tubes may be place in the operating room, at the bedside or under ultrasound guidance. When assisting with insertion, gather the chest tube insertion tray, the chest tube (size to be determined by the physician) and the disposable chest drainage system along with a bottle of sterile water and wide adhesive tape. A local anesthetic is applied and the physician uses a scalpel to dissect down to the pleural space. The chest tube is inserted and immediately attached to the prepared drainage system. (Mann, 2012)

It is important to note that there is more than one type of situation or setting when nurses will have to deal with chest tubes. As with all aspects of the nursing profession, practice is required to master the skill of chest tube insertion. Clearly training in additional equipment such as ultrasound and anesthetic application are necessary so as to reduce the discomfort of the patient as much as possible, after all, these are foreign objects placed within the chest, in very sensitive areas surrounding the lungs. Some bedside manner is likely necessary, too. Nurses should keep in mind that the primary function for the chest tubes are drainage, so if there is a problem with build up of fluid, blood, or irregular presence of air, then maintenance and care for the patience are required.

Chest tubes also may be used to prevent or mitigate postoperative complications. For example, after cardiac surgery or chest trauma, one or more chest tubes may be inserted in the mediastinum to drain blood and prevent cardiac tamponade. In addition, chest tubes can be used to instill fluids into the pleural space, such as chemotherapy drugs or sclerosing agents to treat recurrent pleural effusions (a procedure called pleurodesis). Also, blood collected from chest tubes may be used for autotransfusion. (American Nurse Today)

Certainly, nurses treating patients with chest tubes should check in with those patients physically, verbally, etc. As another way to gain a sense of how well the patient is doing. Furthermore, the patient should not be overexerting him or herself and depending on the personality of the patient, the nurse may have to take a more active role in ensuring that the patient does not participate in activities that may aggravate or displace the chest tubes, even within the home. Nurses can provide additional assistance by educating patients so that they can take better care of themselves. The Ohio State Medical Center provides educational resources and advice such as: