(4) Assist the physician with tube insertion, as directed. There are varying
methods of introducing a tube into the pleural space. The method used depends upon
the size of the tube to be inserted, the equipment available, and the physician's
(5) The physician connects the patient's chest tube and the drainage tubing,
checks the entire system to verify all connections, and tapes the connections to ensure
an airtight system. He will then unclamp the chest tube. The clamps are never
removed until the drainage system is airtight and ready to function.
The chest tube is normally sutured in place and covered with a sterile
Arrange for a follow-up chest X-ray, if ordered.
e. Follow-up Procedures.
Remove equipment from bedside and care for properly.
Observe patient for respiratory difficulty.
Continue to observe the drainage system for proper function.
(4) Tape the padded hemostats and a package of sterile vaseline gauze to
the head of the patient's bed. This equipment must be available for emergency use
should the chest tube become dislodged or the drainage system opened.
(5) Record the procedure in the Nursing Notes. Note the patient's tolerance
to the procedure.
2-25. WATER-SEAL CHEST DRAINAGE
a. General. Underwater-seal chest drainage is a closed (airtight) system for
drainage of air and fluid from the chest cavity.
(1) The underwater-seal system is established by connecting a catheter
(chest tube) that has been placed in the patient's pleural cavity to drainage tubing that
leads to a sealed drainage bottle.
(2) Air and fluid drain into the bottle, but water acts as a seal to keep the air
from being drawn back into the pleural space.
(3) By keeping the drainage bottle at floor level, fluid will be prevented from
being siphoned back.
(4) As air and fluid are drained, pressure on the lungs is relieved and re-
expansion of the lung is facilitated.