Word: Thoracic: Assisting With Chest Tube Insertion
THORACIC: ASSISTING WITH CHEST TUBE INSERTION
DOCUMENT TYPE: PROCEDURE
Site Applicability
This procedure is applicable in Neonatal Intensive Care
Practice Level/Competencies
A pleural chest tube is required any time the negative pressure
in the pleural cavity is disrupted by the presence of air or fluid
resulting in pulmonary compromise. In an urgent situation, needle
aspiration of the fluid/air collection may be required. See
Thoracic: Needle Aspiration Procedure.A chest tube is inserted by a
Physician or Nurse Practitioner.Nipple and breast bud should be
avoided when placing a chest tube.Analgesia either intravenously or
locally is required for chest tube placement unless an emergency
condition exists.
Equipment & Supplies
Local AnaestheticAnalgesia BolusChest drainage unit (Atrium
Oasis)Chest tube drain Pigtail (#6 or #8.5 F) or Trochar (#8 or #10
F)Argyle 5-in-1 barbed connector if inserting a TrocharChest tube
insertion trayDexidin 2 solution (2% chlorhexidine gluconate with
4% isopropyl alcohol)Disposable hat and masksNeedle, 25/28 gauge
and 1 cc syringeEmergency Clamps (non-toothed), 2 Pink waterproof
tapeRequisition, Chest x-raySterile drapes, 1 2Sterile gloves and
gown 3-0 Curved suture setTegaderm, 2-3Suction Regulator &
Suction tubingSteristrip or Episeal strip
Procedure
STEPS
RATIONALE
1. Bring Pod supply cart to bedside.
2. Request assistance.
Notify CNL/CSN when procedure occurring to ensure help is
available
3. Administer analgesia as ordered.
Use intravenous analgesia
4. Don mask and cap, wear eye protection, wash hands.
5. Prepare sterile tray, add:
Chest tube
Skin cleaning solution.
Suture material (if needed)
Smaller 5 in 1 adaptor if trocar chest tube being inserted
6. Set-up chest drainage unit. Secure end of tubing in sterile
towel. Bring unit to bedside.
Refer to Document: Thoracic Chest Tube Drainage System Set-Up
And Trouble-Shooting
Patient end of tubing is capped but sterile towel also gives a
sterile field to work over while connecting tubing.
7. Assist physician/NP in gowning and gloving.
9. Position and comfort infant during procedure.
Position supine or, as with pneumothorax, affected side upright.
Arm should be held above the head to expose side of the chest.
10. Ensure chest site is aseptically prepared according to the
NICU Skin Cleaning Aseptic procedure.
Scrub site with Dexidin solution using side-to-side motion for
30 seconds. Allow to air dry for 60 seconds.
For infants less than or equal to 1000 grams:
Remove residual Dexidin solution on skin using sterile normal
saline or sterile water after the chest insertion procedure is
complete
11. Assist with administration of local anesthetic prior to
chest tube placement
12. Hand physician patient end of connecting tubing in the
sterile drape once chest tube inserted. Assist the physician in
cutting the larger adapter off if necessary and inserting smaller
adapter. Maintain sterile technique when connecting the chest tube
to the chest drainage system
Sterile gloved hand will connect chest tube to connecting
tube.
Trochars are always sutured in place.
Pigtail catheters are not typically sutured for securement.
Secure the pigtail in place under dressing.
13. Note at the skin surface the cm landmark on the chest tube
or mark exit site with a steri-strip or episeal strip.
Allows for easy visualization of chest tube placement.
Document landmark in nursing notes and on BIT.
14. Turn suction regulator on once chest tube is attached to
chest drain unit. Check position of suction bellows:
Bellows need to be visible in the suction monitor window.
Increase the wall suction regulator if needed.
For a -10 cm H2O setting- the bellows do not need to expand to
the mark.
For a -20 cm H2O setting- the bellows do need to expand to the
mark
Note positioning of bellows with different suction settings:
15. Secure connection between chest tube and connecting tubing
with waterproof tape
Tape placement should allow for an unobstructed view of the
connection site.
16. Assist physician with placing Tegaderm dressing.
Occlusive transparent dressing allows for observation of
insertion site and early identification of signs of wound
infection, air leak or slipping of chest tube.
Secure chest tube to a secondary point on the chest or abdomen
using duoderm and waterproof tape.
17. Position infant comfortably to facilitate evacuation of the
pleural contents.
To help drain air, head of bed should be at 30-45 degree
angle.
18. Anticipate immediate chest x-ray, blood gas and increased
monitoring of vital signs.
AP and lateral x-ray views are usually preferred
19. Reassess comfort level of the infant following procedure
Documentation
On Flow Sheet in Registered Nurses notes:Indication for chest
tubeInsertion of and infants tolerance,Level of underwater seal in
suction control chamberAny air leak and fluid drainageTime and
dosage of analgesic doses with double signatures BITLandmark of
chest tube position (ideally centimeter or steri-strip mark at
skin)Hourly Documentation:Site-to-source checkAir leak or fluid
drainageFluctuation in tubing or air leak chamber
References
AAP and American College of Obstetrics and Gynecologists.
Guidelines for Perinatal Care. (2002). 5th ed. Philadelphia:
Mosby.BC Womens Hospital (2016). Thoracic: Needle Aspiration.
Retrieved from
http://policyandorders.cw.bc.ca/resource-gallery/Documents/BC%20Women's%20Hospital%20-%20Neonatal%20Program/NN.16.01%20Thoracic%20Needle%20Aspiration%20Procedure.pdfCotton,
CM and Goldberg, RN. (2005). Air leak syndromes. In A.R. Spitzer
(Ed), Intensive care of the fetus and neonate. 2nd ed.
Philadelphia: Elsevier.Gomella, TL, et al. (2003). Neonatology:
Management, procedures, on-call problems, diseases and drugs. 5th
ed. New York: McGraw-Hill.BC Womens Hospital (2015). Skin Cleaning
Aseptic. Retrieved from
http://policyandorders.cw.bc.ca/resource-gallery/Documents/BC%20Women's%20Hospital%20-%20Neonatal%20Program/NN.04.04%20Skin%20Cleaning%20Aseptic.pdf
Version History
DATE
DOCUMENT NUMBER and TITLE
ACTION TAKEN
15-Jan-2019
C-06-12-60036 Thoracic: Assisting With Chest Tube Insertion
Approved at: Neonatal Leadership Committee
Disclaimer
This document is intended for usewithinBC Childrens and BC
Womens Hospitals only. Any other use or reliance is at your sole
risk. The content does not constitute and is not in substitution of
professional medical advice. Provincial Health Services Authority
(PHSA) assumes no liability arising from use or reliance on this
document.This document is protected by copyright and may only be
reprinted in whole or in part with the prior written approval of
PHSA.
C-06-12-60036 Published Date: 27-Feb-2019
Page 4 of 4 Review Date: 27-Feb-2022
This is a controlled document for BCCH& BCW internal use
only see Disclaimer at the end of the document. Refer to online
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