Although the placement of chest tubes usually falls to physicians, many healthcare workers—be they paramedics or nurses—have had to care for patients with chest tubes in place, either in a hospital setting or during transport. Chest tubes are a critical factor in certain respiratory emergencies, so let’s review the indications for placement and some of the dangerous complications you can avoid when caring for such patients.
Chest tubes are flexible plastic tubes that are inserted into the pleural space through a small incision made in the side of the chest. They are used to evacuate air, fluid, pus, or blood from the chest cavity and are primarily inserted to treat traumatic injuries, most typically:
Once the necessary equipment is assembled, a small incision is made on the affected side of the body, above the fifth rib at the midaxillary line. The tube is inserted into the pleural space and sutured in place. Air and fluid can then flow from the chest or be drawn out through the application of suction. A radiograph of the chest is usually taken to ensure proper placement.
This simple life-saving procedure is highly effective in reestablishing the negative pressure within the chest and reinflating collapsed lungs. But there can be complications, especially during transport. They include:
By protecting the patient during inter- and intra-facility transports, you can prevent these complications. If the chest tube is connected to suction, a portable suction device will be needed for patient relocation. A few things to check before transporting the patient using a portable suction unit are:
Once your suction unit is ready, be sure the patient is, too. Here are a few reminders:
Although chest tubes can correct life-threatening injuries, they must be monitored carefully, especially during patient transport. Be sure to follow these guidelines to ensure your patient’s safety.
2011, Pollak, A., Ed.
Critical Care Transport, American College of Emergency Physicians, Jones and Bartlett.
Editor's note: This blog was originally published MAR 2017 and has recently been updated.