Let's take a look at the skill
chest tube system set up.
So before we get much further,
let's talk about the chest tube itself.
So when this is placed, it can be
placed by the physician at the bedside,
maybe interventional radiology
or the operating room.
So just one thing to know is that we
do not insert a chest tube as a nurse,
this is going to be advanced
practice provider or physician.
However, sometimes when
the chest tube is set up,
they definitely can do this at the
bedside to the safety of the patient.
And we may have to set up the system
and the drainage for a patient.
So let's take a look at that.
So let's look at the
equipment we're going to need,
we're going to need the
chest tube collection unit
and which whatever the
preferences of the physician.
We're going to need
the sterile water.
Luckily, usually this comes on
the back of the system itself
and it's attached to the
system and in the package.
We need our section setup,
we also need some tape
to secure the tubing.
And before we start anything,
always perform your hand hygiene.
We want to make sure we
provide privacy for our patient
and really explain this
procedure to the patient.
Okay, this chest tube itself,
the insertions really scary,
and hopefully that's been
Typically, as a nurse, you may be
with a patient when this happens.
We're also going to talk to them about
the equipment and the setup as well.
Now let's make sure
we put on our gloves
and open the chest
tube collection system.
Now we can remove the sterile
water that comes with the system.
So this is usually neatly packaged in
the back of the actual system itself.
Now we're going to
use that sterile water
and fill the wet suction
chamber to the specified level.
Now we also want to
use sterile water
to fill the suction control
chamber to the specified level.
If you remember,
this is usually at about a -20.
And there will be marks
for you to look at that.
Now once that chest tube is
inserted into the patient,
we want to use a
And we want to make sure we don't
touch the end of the chest tube
and the connection and make sure we
keep those sterile, the sterile ends.
Now we want to secure the
connection using tape,
we just want to make sure this
connection does not get loose,
because this can cause
problems for our patient.
Now it's important
to ensure the tubing
is connected to the
drainage collection system.
And you can see on this image
there's a couple of different ports,
and it's labeled nicely
for you on these systems.
Notice there's the suction port.
Also there's the
port for the patient.
So don't worry about
getting these confused.
These are nicely labeled for you
as the nurse on the system itself.
Now if suction is ordered,
we need to adjust the suction
so that gentle bubbling
in that wet suction
device is noted.
So again, if you remember,
on a wet suction,
we're going to do suction via water and
there will be some gentle bubbling there.
So now let's take a look
at the dry suction device.
So remove the sterile water from
the chest tube drainage system.
And if you remember, this is typically
attached to the drainage system itself.
Now we're going to take
some sterile water,
fill the air leak chamber
to the specified level,
and there's typically a nice really clear
dotted line of where you fill that to.
Then we're going to make sure we
take that little dial the dry suction
and turn it to whatever the correct
level suction is going to be.
we need to check our physician order
and see what level it should be.
Typically it's going to be -20.
Now once the chest tube is
inserted by the physician
or the advanced
you're going to use that non-touch
method to attach the tubing.
Now if you remember,
each part of this is sterile,
so we want to be
really careful here.
So we want to use sterile
technique when we're attaching
the tubing system to
the drainage system.
We really want to
secure this with tape
because we do not want to
get that connection loose.
And ensure that tubing is connected
to the drainage collection system.
And just like the wet,
notice there's 2 suction
there's a valve for that
and for the patient.
So it's really nicely labeled for
you so you don't mix up the tubing.
Now on the dry section to
validate that suction is working,
we're going to look
at that orange bellow
and make sure it's expanded at
or beyond that indicator mark.
Now after we've talked about
and set up both systems,
let's take a look at a few things
we need to look at post procedure.
So we want to place the drainage system
below the level of the patient's chest.
This is really important, it should always
be below the level of the patient's chest.
Now you need a place to
put the drainage system.
Well this can hang on the bedside with
the hangers that come on the system.
Or if need be, the system also has some
really handy foot stands for stability.
You can use these as well if they
need to be sitting on the floor.
Now make sure you trace your
tubing and that's free of kinks.
And you also at this point
can remove your gloves,
perform your hand hygiene and make sure
you document the procedure thoroughly.
We just looked a
lot at system setup.
So let's take a moment and talk
about a really important question.
What part of the chest
tube setup is sterile?
I may give you a few
moments to think about that.
Okay, answer is the
actual inside of the unit.
That's why the sterile water that
actually comes on the back of the unit
to make you remember, "Hey,
use sterile water here, not tap."
Also, don't forget that
connecting the drainage system
to the chest tube on the
patient is definitely sterile.
Now if you think about the chest
tube, where's that coming from?
That's coming from the
thoracic cavity of the patient
and we definitely want
to keep that sterile.