From the Research
Patients with chest tubes should ambulate as soon as medically stable, with proper precautions, to prevent complications and improve outcomes, as supported by the most recent and highest quality study available 1.
Key Considerations for Ambulation and Physical Therapy
- The chest drainage system should be kept below chest level during ambulation to maintain proper drainage and prevent reflux of fluid into the pleural space.
- The tubing should be secured to prevent accidental dislodgement, with coiling of excess tubing to avoid kinks or dependent loops that could impede drainage.
- Physical therapy can begin with gentle range of motion exercises for the affected side, progressing to more active exercises as tolerated, with deep breathing exercises and incentive spirometry being particularly beneficial.
- Pain management is essential before ambulation or therapy sessions, typically with scheduled analgesics like acetaminophen, NSAIDs, or opioids as needed, as shown in studies such as 2.
- Patients should be monitored for signs of respiratory distress, subcutaneous emphysema, or changes in drainage during activity, and the activity level should be gradually increased based on the patient's tolerance and clinical improvement.
Benefits of Early Mobilization
- Early mobilization helps prevent complications like pneumonia, muscle deconditioning, and venous thromboembolism, as discussed in studies like 3.
- It can also potentially shorten hospital stays, as suggested by the study on outpatient chest tube management 4.
- The use of a steerable chest tube with an extendable infusion cannula, as described in 1, may also help in preventing retained hemothorax and improving patient outcomes.
Nursing Management and Patient Education
- Nursing management of patients with chest tubes is crucial, and little has been written on this topic, highlighting the need for standardized guidelines, as mentioned in 5.
- Patient education and support are essential for early mobilization and prevention of complications, and patients should be educated on proper chest tube care and management.