f. Observe the patient carefully for any signs of respiratory difficulty, cyanosis,
chest pressure, crepitus, and/or hemorrhage.
Monitor vital signs every 4 hours, or as ordered, and record.
Auscultate patient's lung sounds every 4 hours and record findings.
g. Check to see that the drainage bottle is secured to the floor or is in a special
Prevent bottle from being kicked or tipped over.
Caution visitors against handling equipment.
h. Observe the dressing at the chest tube insertion site for air leakage or
Dressing changes are performed only according to physician's orders.
Observe skin condition during dressing changes and record.
i. Encourage the patient to cough and deep breath at least every 2 hours or as
(1) Patient should be assisted to a sitting position if possible to promote
effective deep breathing and coughing.
A pillow or blanket should be used to splint the affected area.
j. Encourage the patient to change position every 2 hours to promote drainage
and prevent complications; make sure tubing remains free from kinks and is in proper
k. Encourage the patient to perform range of motion exercises for the affected
upper extremity to maintain joint mobility.
l. Transport or ambulate a patient with a chest tube carefully, keeping the
water-seal unit below chest level and upright at all times.
(1) Assist or instruct personnel from other departments in transporting or
ambulating the patient.
Nursing staff should accompany the patient.
(3) Disconnect the closed chest drainage system from suction for
transportation or ambulation; make sure air vent rod is open.