What is the role of a registered nurse (RN) when assisting with chest tube placement?

Role of a Registered Nurse in Chest Tube Placement

Registered nurses play a critical role in assisting with chest tube placement by providing pre-procedural preparation, procedural assistance, and post-procedural management to ensure optimal patient outcomes and prevent complications. 1

Pre-Procedure Responsibilities

• Prepare the patient by providing clear explanations about the procedure, addressing concerns, and obtaining informed consent as directed by the physician 2
• Gather necessary equipment including the chest tube kit, drainage system, sterile supplies, and emergency equipment 1
• Position the patient appropriately, typically in semi-Fowler's position for anterior approach (2nd-3rd intercostal space) or lateral recumbent position for lateral approach (4th-5th intercostal space) 3
• Assist with administration of analgesics and sedatives as ordered, monitoring for adverse effects 2
• Ensure intravenous access is established and maintained throughout the procedure 2

During Procedure Responsibilities

• Maintain sterile field and assist with aseptic technique throughout the procedure 1
• Hand instruments and supplies to the physician as needed during the insertion process 4
• Monitor patient's vital signs, oxygen saturation, and level of comfort throughout the procedure 2
• Assist with administration of local anesthetic (typically 20-25 ml of 1% lidocaine) to reduce pain during insertion 2
• Support the patient psychologically during the procedure, providing reassurance and comfort measures 2
• Assist with securing the chest tube after insertion using appropriate sutures, dressings, or fixation devices 1

Post-Procedure Responsibilities

• Connect the chest tube to the appropriate drainage system (underwater seal bottle or commercial chest drainage unit) and ensure it remains below the level of the patient's chest 1
• Monitor the drainage system for:
  • Air leaks (bubbling in the water seal chamber) 2
  • Drainage volume, color, and consistency 2
  • Respiratory swing (fluctuation of fluid level with breathing) 1
• Ensure the chest tube is not kinked, clamped inappropriately, or obstructed 1
• Obtain a post-procedure chest radiograph to confirm proper tube placement and assess for pneumothorax resolution 1
• Document the procedure, including tube size, insertion site, amount and characteristics of drainage, and patient's response 4

Ongoing Management

• Maintain the drainage system in proper position (below chest level) at all times, including during patient transport 4
• Monitor for complications such as:
  • Subcutaneous emphysema 1
  • Tube dislodgement or displacement 3
  • Infection at insertion site 1
  • Persistent air leak beyond 48 hours 2
• Provide appropriate pain management, including administration of intrapleural local anesthetic as ordered 2
• Maintain chest tube patency without breaking the sterile field 1
• Never clamp a bubbling chest tube as this could convert a simple pneumothorax into a life-threatening tension pneumothorax 2, 1

Important Safety Considerations

• If a patient with a clamped drain becomes breathless or develops subcutaneous emphysema, immediately unclamp the drain and seek medical advice 2
• Refer patients with pneumothoraces that fail to respond within 48 hours to a respiratory physician 2
• Ensure proper documentation of all assessments, interventions, and patient responses 4
• Maintain specialized knowledge and skills through ongoing education in chest tube management 2

Specialized Training Requirements

• Registered nurses assisting with chest tube placement should have critical care experience, knowledge of cardiovascular medications, and experience with vascular catheter instrumentation 2
• Nurses should be familiar with the overall function of the procedure, help set the tone of the patient surroundings, and influence the efficiency and safety of procedures 2
• Cross-training among laboratory staff should be adequate to provide 24-hour coverage of essential team functions 2