Caring for patients with chest tubes is a critical skill for every registered nurse (RN). Whether you’re working in med-surg, critical care, or emergency nursing, understanding chest tube management is essential for ensuring patient safety and effective treatment.
If you’re preparing for the NCLEX, this is one of those high-yield nursing topics you must master. Let’s break it down in simple terms to help you care confidently and competently.
💡 What Is a Chest Tube?
A chest tube (thoracostomy tube) is a flexible plastic tube inserted into the pleural space to remove air, fluid, or blood. The goal is to re-expand the lung and restore normal breathing.
Chest tubes are used for:
- Pneumothorax (air in the pleural space)
- Hemothorax (blood in the pleural space)
- Pleural effusion (fluid buildup)
- Post-surgical drainage after thoracic or cardiac surgery
For every nurse, knowing how to monitor and maintain a chest drainage system is vital to prevent complications.
🩺 The RN Nurse’s Role in Chest Tube Care
As a registered nurse, your responsibilities include:
- Assessing Respiratory Status
- Monitor breath sounds, oxygen saturation, and respiratory effort.
- Report changes such as sudden dyspnea or decreased lung sounds.
- Checking the Chest Drainage System
- Ensure the system is below the level of the chest to allow gravity drainage.
- Keep tubing free from kinks or dependent loops.
- Check for fluctuations (tidaling) in the water seal chamber — this shows the tube is patent.
- Observing for Air Leaks
- Continuous bubbling in the water seal chamber indicates an air leak.
- Clamp briefly (if allowed by policy) to locate the source — never leave it clamped!
- Measuring Drainage
- Record color, consistency, and amount every shift.
- Report drainage over 100 mL/hr or sudden changes.
- Ensuring the Dressing Is Secure
- Keep a sterile occlusive dressing around the insertion site.
- Change it per facility protocol, using aseptic technique.
- Providing Emotional Support
- Reassure the patient that discomfort is temporary.
- Educate them on breathing exercises to prevent lung collapse.
⚠️ Nursing Interventions for Common Complications
| Complication | Nursing Action |
|---|---|
| Accidental Tube Dislodgement | Apply sterile occlusive dressing, notify provider immediately. |
| System Disconnection | Immerse tube end in sterile water to maintain water seal. |
| No Drainage or Tidaling | Check for kinks or blockages; assess patient’s condition. |
| Sudden Dyspnea or Cyanosis | Call rapid response, monitor O₂ saturation, prepare for possible tension pneumothorax. |
📘 NCLEX Nursing Tips
If you’re studying with a nursing bundle, chest tube care will appear in NCLEX questions that test patient safety and prioritization.
Here’s what you need to remember:
- Never clamp the chest tube unnecessarily.
- Keep two hemostats, sterile water, and an occlusive dressing at the bedside.
- Monitor for subcutaneous emphysema (air under the skin — feels like crackling).
- Encourage deep breathing, coughing, and use of the incentive spirometer.
These actions show strong critical thinking — exactly what the NCLEX evaluates.
🧠 Patient Education
Every nurse should educate the patient and family on:
- Avoiding tension or pulling on the tubing.
- Reporting increased pain, shortness of breath, or drainage changes.
- Performing breathing exercises as instructed.
Patient education not only promotes healing but also empowers them to participate in care — a vital nursing principle.
🧾 Final Thoughts
Caring for patients with chest tubes demands knowledge, vigilance, and empathy. As a registered nurse (RN), your role is to monitor, protect, and educate — ensuring safety while promoting recovery.
FAQs About Caring for Patients With Chest Tubes
To remove air, blood, or fluid from the pleural space, allowing the lung to re-expand.
Always below the chest level, never on the bed or patient.
Place the end in sterile water to maintain a seal, then notify the provider.
Drainage amount, respiratory status, dressing integrity, and signs of infection.