Chest tubes are essential medical devices used to drain air, blood, or fluid from the pleural space surrounding the lungs. Understanding the nursing diagnoses associated with chest tubes is crucial for providing optimal patient care and preventing complications. This comprehensive guide covers essential nursing diagnoses, assessments, interventions, and care plans for patients with chest tubes.
Understanding Chest Tubes and Their Purpose
A chest tube (thoracostomy tube) is inserted through the chest wall into the pleural space to remove accumulated air or fluid, helping restore normal lung function. The tube connects to a drainage system that maintains negative pressure in the pleural space, allowing proper lung expansion.
Common Indications for Chest Tube Placement
- Pneumothorax (collapsed lung)
- Hemothorax (blood in pleural space)
- Post-surgical drainage
- Pleural effusions
- Empyema (infection in pleural space)
- Chylothorax (lymphatic fluid accumulation)
Nursing Assessment for Chest Tubes
Initial Assessment
Respiratory Status
- Breath sounds
- Respiratory rate and pattern
- Oxygen saturation
- Use of accessory muscles
- Chest wall movement
Chest Tube System
- Proper connections
- Drainage amount and characteristics
- Suction level
- Water seal chamber function
- Evidence of air leaks
Insertion Site
- Dressing integrity
- Signs of infection
- Subcutaneous emphysema
- Tube position and security
Ongoing Monitoring
Drainage Assessment
- Color
- Amount
- Consistency
- Presence of air leaks
Patient Status
- Vital signs
- Pain level
- Respiratory effort
- Activity tolerance
Chest Tube Nursing Care Plans
1. Ineffective Breathing Pattern
Nursing Diagnosis Statement:
Ineffective Breathing Pattern related to decreased lung expansion secondary to pleural effusion/pneumothorax as evidenced by dyspnea, tachypnea, and decreased chest expansion.
Related Factors/Causes:
- Pleural effusion
- Pneumothorax
- Pain
- Anxiety
- Chest tube malposition
Nursing Interventions and Rationales:
- Assess respiratory rate, depth, and pattern every 2-4 hours
Rationale: Early detection of respiratory deterioration allows prompt intervention - Position patient in semi-Fowler’s position
Rationale: Promotes optimal lung expansion and reduces work of breathing - Encourage deep breathing exercises and incentive spirometry
Rationale: Prevents atelectasis and promotes lung re-expansion - Monitor chest tube system for proper functioning
Rationale: Ensures effective drainage and maintains negative pressure
Desired Outcomes:
- The patient maintains a respiratory rate of 12-20 breaths/minute
- Demonstrates improved chest expansion
- Reports decreased dyspnea
- Maintains oxygen saturation >95% on room air
2. Risk for Infection
Nursing Diagnosis Statement:
Risk for Infection related to invasive procedure and presence of chest tube as evidenced by risk factors present.
Related Factors/Causes:
- Invasive procedure
- Break in skin integrity
- Presence of foreign body (chest tube)
- Compromised host defenses
Nursing Interventions and Rationales:
- Maintain sterile technique during dressing changes
Rationale: Prevents introduction of microorganisms - Monitor the insertion site for signs of infection
Rationale: Enables early detection and treatment - Maintain a closed drainage system
Rationale: Prevents contamination and maintains sterility - Monitor temperature and white blood cell count
Rationale: Identifies systemic infection early
Desired Outcomes:
- The insertion site remains free from signs of infection
- The patient maintains a normal temperature
- Demonstrates normal white blood cell count
- Shows no signs of systemic infection
3. Acute Pain
Nursing Diagnosis Statement:
Acute Pain related to surgical incision and chest tube presence as evidenced by verbal reports of pain, guarding behavior, and facial grimacing.
Related Factors/Causes:
- Surgical incision
- Tissue trauma
- Chest tube movement
- Pleural irritation
Nursing Interventions and Rationales:
- Assess pain characteristics regularly
Rationale: Determines effectiveness of pain management - Administer prescribed analgesics
Rationale: Reduces pain and promotes comfort - Teach splinting techniques during coughing/deep breathing
Rationale: Minimizes pain during necessary respiratory exercises - Secure the chest tube properly
Rationale: Prevents tube movement and reduces discomfort
Desired Outcomes:
- Reports pain level ≤3/10
- Participates in necessary activities without significant pain
- Uses pain management strategies effectively
- Demonstrates improved comfort level
4. Impaired Physical Mobility
Nursing Diagnosis Statement:
Impaired Physical Mobility related to pain and presence of chest tube drainage system as evidenced by reluctance to move and difficulty with position changes.
Related Factors/Causes:
- Pain at the insertion site
- Fear of tube dislodgement
- Attachment to the drainage system
- Restricted movement due to equipment
Nursing Interventions and Rationales:
- Assist with gradual mobilization
Rationale: Promotes independence while ensuring safety - Secure drainage system during movement
Rationale: Prevents accidental tube displacement - Teach safe movement techniques
Rationale: Increases patient confidence and promotes independence - Maintain chest tube system below chest level during mobility
Rationale: Ensures proper drainage and prevents fluid backflow
Desired Outcomes:
- Demonstrates safe mobility techniques
- Participates in progressive mobility program
- Maintains chest tube placement during movement
- Shows increased independence in activities
5. Anxiety
Nursing Diagnosis Statement:
Anxiety related to presence of chest tube and unfamiliarity with equipment as evidenced by expressed concerns, restlessness, and increased vital signs.
Related Factors/Causes:
- Unfamiliarity with equipment
- Fear of complications
- Uncertain prognosis
- Limited understanding of the procedure
Nursing Interventions and Rationales:
- Provide clear explanations about chest tube function
Rationale: Increases understanding and reduces anxiety - Teach recognition of normal versus abnormal findings
Rationale: Empowers patient and reduces fear - Encourage expression of concerns
Rationale: Allows addressing specific fears and misconceptions - Maintain a calm, confident demeanor
Rationale: Helps reduce patient anxiety through modeling
Desired Outcomes:
- Verbalizes understanding of chest tube purpose
- Demonstrates decreased anxiety levels
- Participates in care activities
- Shows improved comfort with equipment
References
- Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
- Anderson D, Chen SA, Godoy LA, Brown LM, Cooke DT. Comprehensive Review of Chest Tube Management: A Review. JAMA Surg. 2022 Mar 1;157(3):269-274. doi: 10.1001/jamasurg.2021.7050. PMID: 35080596.
- Gan KL, Tan M. Evidence-based management of patients with chest tube drainage system to reduce complications in cardiothoracic vascular surgery wards. Int J Evid Based Healthc. 2015 Jun;13(2):58-65. doi: 10.1097/XEB.0000000000000041. PMID: 26057649.
- Harding, M. M., Kwong, J., & Hagler, D. (2022). Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems, Single Volume. Elsevier.
- Herdman, T. H., Kamitsuru, S., & Lopes, C. (2024). NANDA International Nursing Diagnoses – Definitions and Classification, 2024-2026.
- Ignatavicius, D. D., Rebar, C., & Heimgartner, N. M. (2023). Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care. Elsevier.
- Silvestri, L. A. (2023). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.
- Tcherveniakov P, De Siqueira J, Milton R, Papagiannopoulos K. Ward-based, nurse-led, outpatient chest tube management: analysis of impact, cost-effectiveness and patient safety. Eur J Cardiothorac Surg. 2012 Jun;41(6):1353-5; discussion 1356. doi: 10.1093/ejcts/ezr231. Epub 2012 Feb 17. PMID: 22342975.
