The client has chest tubes in place following thoracic surgery. In working with a client who has a chest tube, the nurse should:

Question

1. Clamp the tubes except during client assessments
2. Remove the tubing from the connection to check for adequate suction power
3. Milk or strip the tubes every 15 to 30 minutes to maintain drainage
4. Coil and secure excess tubing next to the client

Answer 1

ANS: 4
If the client is in a chair and the tubing is coiled, the tubing should be lifted every 15 minutes to promote drainage. Care should be taken to ensure the tubing remains secure. Clamping the tubes except during client assessments is an inaccurate statement. Clamping a chest tube is contraindi-cated when the client is ambulating or being transported. In a water-sealed system, gentle bub-bling in the suction-control chamber indicates it is functioning. The suction source may be checked to verify it is on the appropriate setting. In a waterless system, the suction control (float ball) indicates the amount of suction the client's intrapleural space is receiving. The tubing should not be disconnected. The chest tube should be stripped or milked only if indicated (e.g., there is clotted drainage in the tube) (check institutional policy). It is believed that stripping the tube greatly increases intrapleural pressure, which could damage the pleural tissue and cause or worsen an existing pneumothorax. Milking causes less of a pressure change.