OXYGEN THERAPY

Administering oxygen therapy

 Oxygen is an odorless, tasteless, colorless, transparent gas that is slightly
heavier than air. oxygen can be dispensed from a cylinder tank, piped-in system,
liquid oxygen reservoir, or oxygen concentrator.
The method it may be administered depends on:
 the required concentration of oxygen
 desired variability in delivered oxygen concentration
(none, minimal, moderate)
 required ventilatory assistance
(mechanical ventilator, spontaneous breathing)
Methods of oxygen administration
1. Nasal cannula – nasal prongs that deliver low flow of
oxygen.
a. Requires nose breathing
b. Cannot deliver oxygen concentration much higher than 40%.
Approximate oxygen concentrations delivered via nasal cannula are:
 1 L/min = 24% to 25%
 2 L/min = 27% to 29%
 3 L/min = 30% to 33%
 4 L/min = 33% to 37%
 5 L/min = 36% to 41%
 6 L/min = 39% to 45%
2. Simple Face Mask – mask that delivers moderate oxygen flow to
nose and mouth.
a. Delivers oxygen concentrations to 40% to 60%.

3. Venturi Mask – mask with device that mixes air and oxygen to
deliver constant oxygen concentration.
a. It mixes a fixed flow of oxygen with a high but variable flow
of air to produce a constant oxygen concentration. Oxygen
enters by way of a jet (restricted opening) at a high
velocity. Room air also enters and mixes with oxygen at
this site. The higher the velocity (smaller the opening), the
more room air is drawn into the mask.
b. Virtually eliminates rebreathing of carbon dioxide. Excess
gas leaves through openings in the mask, carrying with it
the expired carbon dioxide.
4. Partial Rebreather Mask – has an inflatable bag that stores
100% oxygen.
a. On inspiration, the patient inhales from the mask and bag;
on expiration the bag refills with oxygen and expired gases
exit through perforations on both sides of the mask and
some enters bag.
b. High concentrations of oxygen (50% to 75%) can be
delivered.
5. Nonrebreathing Mask – has an inflatable bag to store 100%
oxygen and a one-way valve between the bag and mask to prevent
exhaled air from entering the bag.
a. Has one-way valves covering one or both the exhalation
ports to prevent entry of room air on inspiration.
b. Has a flap or spring-loaded valves to permit entry of room air
should the oxygen source fail or patient needs exceed the
available oxygen flow.
c. Optimally, all the patient’s inspiratory volume will be
provided by the mask/reservoir, allowing delivery of nearly
100% oxygen.
6. Transtracheal Catheter – accomplished by way of a small
(8Fr) catheter inserted between the second and third tracheal
cartilage.
a. Does not interfere with talking, drinking, or eating and
can be concealed under a shirt or blouse.
b. Oxygen delivery is more efficient because all oxygen
enters the lungs.
c. Patients who meet criteria for continuous home oxygen
therapy (PaO2 < 55 mmHg on room air) may use this
delivery method instead of nasal cannula.
7. Continuous Positive Airway Pressure (CPAP) Mask – is
used to provide expiratory and inspiratory positive airway pressure
in a manner similar to positive end expiratory pressure (PEEP) and
without endotracheal intubation.
a. Has an inflatable cushion and head strap designed to tightly
seal the mask against the face.
b. A PEEP valve is incorporated into the exhalation port to
maintain positive pressure on exhalation.
c. High inspiratory flow rates are needed to maintain positive
pressure on inspiration.

8. T-piece (Briggs) Adapter – is used to administer oxygen to

patient with endotracheal and tracheostomy tube who is
breathing spontaneously.
a. High concentration of humidity and oxygen delivered
through wide bore tubing.
b. Expired gases exits through open reservoir tubing.

9. Manual Resuscitation Bag (Ambu Bag) – delivers high

concentration of oxygen to patient with insufficient inspiratory
effort.
a. With mask, uses upper airway by delivering oxygen to
mouth and nose of patient.
b. Without mask, adapter fits on endotracheal or
tracheostomy tube.
c. Usually used in cardiopulmonary arrest, hyperinflation
during suctioning, or transport of ventilator-dependent
patients.
Pulse oximetry
  Pulse oximetry (SpO2) is a non-invasive optical method of monitoring arterial
oxygen saturation. It provides an early and immediate warning of impending
hypoxemia.
 Oximeters function by passing a light beam through a vascular bed, such as the
finger or earlobe to determine the amount of light absorbed by oxygenated (red)
and deoxygenated (blue) blood.
 Calculates the amount of arterial blood that is saturated with oxygen and displays
as a digital value.
 Indications include:
a. Unstable patient who may experience sudden changes in oxygen level
Evaluation of need for home oxygen therapy
b. Need to follow the trend but need to decrease number of arterial blood gas
(ABG) drawn.
 Normal Value: SpO2 ≥ 95%
 Significance of abnormal values:
When the arterial saturation is lower than 95%. It could be the result of a variety
of causes. It may signify that the respiratory effort or oxygen delivery system is
inadequate to meet the tissue needs or that cardiac output is impaired, resulting
in tissue hypoxia. If arterial flow to the sensor is impaired for any reason, it could
result in an erroneously low reading while tissue oxygenation is adequate;
therefore, it is important to correlate the reading with other assessment
parameters.
 Nursing Considerations:
a. Assess patient’s hemoglobin status. Oxygen saturation may not correlate
well with if hemoglobin is not within normal limits.
b. Remove patient’s nail polish because it can affect the ability of the sensor
to correctly determine oxygen saturation.
c. Correlate oximetry with arterial blood gas (ABG) and then use for single
reading or trending of oxygenation
d. Assess site of oximetry monitoring for perfusion and rotate sensor sites on
regular basis.

USING A PULSE OXIMETER

ACTION RATIONALE
1. Identify the patient at least two methods.  Positive identification of the patient
is essential to ensure the
intervention is administered to the
correct patient.
2. Explain what are you going to do and why  Explanation relieves anxiety and
are you going to do it with the patient. facilitates cooperation.
3. Perform hand hygiene.  This deters the spread of
microorganism.
4. Select an adequate size for the  Inadequate circulation can interfere
application of the sensor. with the oxygen saturation reading.
a. Use the patient's index or ring finger  Fingers are easily accessible
b. Check the proximal pulse and  Brisk capillary refill and a strong
capillary refill pulse
indicate that circulation to the site is
adequate
c. If circulation at site is inadequate,  These alternate sites are highly
consider using the earlobe or bridge vascular
of nose alternatives
d. Use the toe only if lower extremity  Peripheral vascular disease is
circulation is not compromised. common in
lower extremities
5. Select proper equipment:
a. If one finger is too large for the  Inaccurate readings can result if
probe, use a smaller one. A pediatric probe is
probe may be used for a small adult. not attached accurately.
b. Use probes appropriate for patient’s  Probes comes in adult, pediatric, and
 age and size. infant sizes.
c. Check if patient is allergic to  A reaction may occur if patient is
adhesive. A non-adhesive finger clip allergic
or reflectance sensor is available, to adhesive substance.
6. Prepare the monitoring site. Cleanse the  Skin oils, dirt, or grime on the site,
selected area with alcohol wipe or polish and artificial nails can interfere
disposable cleaning cloth. Allow the area with the passage of light waves.
to dry. If necessary, remove nail polish
and artificial nails after checking the
manual.
7. Apply probe securely to skin. Make sure  Secure attachment and proper
that the light-emitting sensor and the alignment promote satisfactory
light-receiving sensor are aligned operation of the
opposite each other (not necessary to equipment and accurate recording of the
check if placed on forehead or bridge of SpO2.
nose).
8. Connect the sensor probe to the pulse  Audible beep represents the arterial
oximeter, turn the oximeter one, and pulse, and fluctuating waveform or
check operation of the equipment light bar indicates the strength of the
(audible beep, fluctuation of bar of light pulse. A
or waveform on space of oximeter. weak signal will produce an inaccurate
recording of the SpO2. Tone of beep
reflects SpO2 reading. If SpO2 drops, tone
becomes lower in pitch.
9. Set alarms on pulse oximeter. Check  Alarm provides additional safeguard
manufacturer's alarm limits for high and and
low pulse rate settings. signals when high or low limits have been
surpassed.
10. Check oxygen saturation at regular  Monitoring SpO2 provides ongoing
intervals, as ordered by physician and assessment of patient’s condition. A low
signaled by alarms. Monitor hemoglobin hemoglobin level may be satisfactorily
level. saturated yet inadequate to meet
patient’s oxygen needs.
11. Remove sensor on a regular basis and  Prolonged pressure may lead to
check for skin irritation or signs of tissue
pressure (every 2 hours for spring tension necrosis. Adhesive sensor may cause
sensor or every 4 hours for adhesive skin irritation.
finger or toe sensor).
12. Clean non-disposable sensors according  Each deters the spread of
to manufacturer’s directions. Perform microorganism.
hand hygiene.

DIAGNOSTIC PROCEDURE (Respiratory Function)

1. Arterial Blood Gas (ABG) Analysis
 A measurement of oxygen, carbon dioxide, as well as the pH of the blood that
provides a means of assessing the adequacy of ventilation and oxygenation.
 Blood can be obtained from any artery but it is most withdrawn from the radial,
brachial or femoral site.
 Interpret ABGs by looking at the following:
(P equals pressure)
a. PaO2 – partial pressure of oxygen in arterial blood (greater than 95 to
100 mmHg)
b. PacO2 – partial pressure of carbon dioxide in arterial blood (greater
than 35 to 45 mmHg)
c. SaO2 – saturation of oxygen in arterial blood (greater than 95%)
d. pH – hydrogen ion concentration, or degree of acid-base balance (7.35
to 7.45)
 Nursing Responsibilities:
 applying pressure to the puncture site for 3 to 5 minutes and when bleeding has
stopped, tape a gauze pad firmly over it.
 If the puncture site is on the arm, don’t tape the entire circumference because
this may restrict circulation.
 If the patient is receiving anticoagulants or has a coagulopathy, apply pressure
to the puncture site longer than 5 minutes if necessary.
 Monitor vital signs and observe for signs of circulatory impairment.
2. Sputum Examination
 Sputum is obtained for evaluation of:
a. gross appearance
b. microscopic examination (shows presence of white blood cells)
c. Gram’s stain (detect the presence of bacteria and sometimes fungi in a
sample taken)
d. Culture (used to make diagnosis, determine drug sensitivity, and serve as
a guide for correct choice of antibiotics)
e. Cytology (used to identify tumor cells)
 It is important that the sputum be collected correctly and that the specimen be
sent to laboratory immediately.
 Sputum can be obtained by:
a. Deep breathing and coughing – obtain early morning specimen because it
yields best sample of deep pulmonary secretions
b. Trachea suction – aspiration of secretions through tubes
Purposes:
 To isolate and identify causes of pulmonary infections.
 To aid diagnosis of respiratory diseases, such as bronchitis, tuberculosis, lung
abscess, and pneumonia.
Preparation:
 Inform the patient that his test requires a sputum specimen.
 Explain that the specimens may be collected on at least three consecutive
mornings if the suspected organism is Myobacterium Tuberculosis.
 Inform the patient that result for TB cultures take up to 2 months.
Nursing Responsibilities:
 Provide mouth care to the patient.
 Monitor his vital signs and respiratory status.
 Monitor oxygen saturation with a pulse oximeter.
 If the patient becomes hypoxic or cyanotic during suctioning, remove the
catheter immediately and give oxygen while suctioning pulse oximetry.
3. Pleural Fluid Analysis
 Abnormal accumulation of pleural fluid (effusion) occurs in the diseases of the
pleura, heart, or lymphatics. The pleural fluid collected is studied to determine the
underlying cause.
 It is obtained by aspiration (thoracentesis) or by tube thoracotomy (chest tube
insertion)
 The fluid is examined for cell count, differential, specific gravity, cytology, protein,
glucose, pH, LDH, and amylase.
 Pleural fluid is usually light straw colored.
THORACENTESIS
Equipment:
- Syringes 5ml, 20ml, 50ml
- Needles No.22, No.26, No.16
- Three-way stopcock
- Hemostat
- Biopsy Needle
- Germicide Solution
- Lidocaine
- Sterile gauze sponges
- Sterile towels and drapes
- Sterile specimen containers
- Sterile gloves
4. Chest X-Ray
 Also known as “Roentgenogram” (derived from the name of Willhelm Conrad
Roentgen – the Father of Diagnostic Radiology)
 This test shows the position of normal structures, displacement, and presence of
abnormal shadows. Normal pulmonary tissue is radiolucent and appears black
on film. Thus, densities produced by tumors, foreign bodies, infiltrates, and so
forth can be detected as lighter or white images.
 Nursing/Patient Care Considerations
 Should be taken upright if patient’s condition permits. Assist Radiologic
Technician at bedside in preparing patient for portable chest x-ray.
 Encourage patient to take deep breath and hold breath as x-ray is taken.
 Ensure all jewelry or metal objects in x-ray field are removed so as not to
interfere with the film
5. Computerized Axial Tomography (CAT, CT SCAN)
 An imaging method in which the lungs are scanned in successive layers by a
narrow x-ray beam. A computer printout is obtained of the absorption values of
the tissues in the plane being scanned.
 It may be used to define pulmonary nodules or to demonstrate mediastinal
abnormalities and hilar adenopathy.
Nursing / Patient Care Consideration:
 Describe test to patient/family and ensure consent is obtained. Test takes about
30 minutes.
 Be alert to any allergies to iodine or contrast dye that may be used during testing.
 If for Contrast Scan, make sure that the Creatinine level of the patient is within
normal range.
6. Magnetic Resonance Imaging (MRI)
 A type of emission of tomography based on magnetizing patient tissue,
generating a weak electromagnet signal, and mapping that signal for
visualization.
 Provides contrast between various soft tissues, and contrast media is not
necessary.
Nursing / Patient Care Consideration:
 Explain the procedure to patient and assess ability to remain still in a closed
space; sedation may be necessary
 Evaluate patient for magnetic implants such as pacemakers, prosthetic
valves, or joints, which preclude the use of MRI.
 Evaluate patient for claustrophobia and teach relaxation techniques to use
during the test; sedation may be necessary.
7. Bronchoscopy
 The direct inspection and observation of the larynx, trachea, and bronchi through
flexible or rigid bronchoscope.
a. Flexible fiberoptic bronchoscope allows for more patient comfort and
better visualization of smaller airways
b. Rigid bronchoscopy is preferred for small children and endobronchial
tumor resection
 Has both diagnostic and therapeutic uses in pulmonary conditions.
a. Diagnostic Uses:
 Collecting secretions for cytologic/bacteriological studies
 Determining location and extent of pathologic process and to obtain
tissue for biopsy o culture
 Determining whether a tumor can be resected surgically
 Diagnosing bleeding sites (source of hemoptysis)
b. Therapeutic Uses;
 Removal of foreign bodies or thickened secretions from
tracheobronchial tree and the excision of lesions.
Nursing / Patient Care Consideration:
  See that an informed consent has been signed.
 Administer prescribed medication to reduce secretions, block the vasovagal
reflex, and relieve anxiety. Give encouragement and nursing support.
 Restrict fluid and food intake for 6 to 12 hours before procedure (to
reduce risk of aspiration when reflexes are blocked)
 Remove dentures, contact lenses and other prostheses.
 After the procedure:
a. Monitor cardiac rhythm
b. Monitor respiratory effort
c. Consider monitoring oximetry
 Report cyanosis, hypotension, tachycardia or dysrhythmia, hemoptysis, dyspnea,
decreased breath sounds.
8. Oximetry
 Oximeters function by passing a light beam through a vascular bed, such as the
finger or earlobe to determine the amount of light absorbed by oxygenated (red)
and deoxygenated (blue) blood.
 Calculates the amount of arterial blood that is saturated with oxygen and displays
as a digital value.
 Indications include:
a. Unstable patient who may experience sudden changes in oxygen level
b. Evaluation of need for home oxygen therapy
c. Need to follow the trend but need to decrease number of arterial blood gas
(ABG) drawn.
 Normal Value: SpO2 ≥ 95%
 Significance of abnormal values:
When the arterial saturation is lower than 95%. It could be the result of a variety
of causes. It may signify that the respiratory effort or oxygen delivery system is
inadequate to meet the tissue needs or that cardiac output is impaired, resulting
in tissue hypoxia. If arterial flow to the sensor is impaired for any reason, it could
result in an erroneously low reading while tissue oxygenation is adequate;
therefore, it is important to correlate the reading with other assessment
parameters.
Nursing Consideration:
 Assess patient’s hemoglobin status. Oxygen saturation may not correlate well
with if hemoglobin is not within normal limits.
 Remove patient’s nail polish because it can affect the ability of the sensor to
correctly determine oxygen saturation.
 Correlate oximetry with arterial blood gas (ABG) and then use for single reading
or trending of oxygenation
 Assess site of oximetry monitoring for perfusion and rotate sensor sites on
regular basis.
9. Lung Biopsy
 Procedures used for obtaining histological material from the lung to aid in
diagnosis. These include:
a. Transbroschopic biopsy – biopsy forceps inserted through
bronchoscope and specimen of lung tissue obtained.
b. Transthoracic needle aspiration biopsy – specimen obtained through
needle aspiration through fluoroscopic guidance.
c. Open lung biopsy – specimen obtained through small anterior
thoracotomy; used in making a diagnosis when other biopsy methods
have not been effective or are not possible.
Nursing Consideration:
 Obtain informed consent
  Observe for possible complications including pneumothorax, hemorrhage
(hemoptysis), and bacterial contamination of pleural space

CHEST DRAINAGE
 Chest drainage is the insertion of a tube into the pleural space to evacuate air or
fluid, to help regain negative pressure.

 Whenever the chest is opened, there is loss of negative pressure, which can
result in collapse of the lung.
 The collection of air, fluid, or other substances in the chest can compromise
cardiopulmonary function and even cause collapse of the lung, because these
substances take up space.
 Chest drainage can also be used to treat spontaneous pneumothorax or
hemothorax caused by trauma.
Sites for chest tube placement:
a. For pneumothorax (air) – 2nd or 3rd interspace along midclavicular or
anterior axillary line
b. For hemothorax (fluid) – 6th or 7th lateral interspace in the midaxillary
line.
Principles of chest drainage
 Many types of commercial chest drainage systems are in use, most of which use
the water-seal principle. The chest tube is attached to a bottle, using a one-
way valve principle. Water act as a seal and permits air and fluid to drain from
the chest. However, air cannot reenter the submerged tip of the tube.
Three Types of Systems:
1. Single-Bottle Water-Seal System 2. Two-Bottle Water-Seal System

3. Three-Bottle Water-Seal System

Nursing / Patient Care Consideration:

 Assist with chest tube insertion
 Assess patient’s pain at insertion site and give medication appropriately. If
patient is in pain, chest excursion and lung inflation will be hampered.
 Maintain chest tubes to provide drainage and enhance lung reinflation.
Assisting with Chest Tube Insertion
Nursing Action Rationale
Preparatory Phase
1. Assess patient for pneumothorax,
hemothorax, presence of respiratory
disease
2. Obtain a chest x-ray. Other means of  To evaluate extent of lung
localization of pleural fluid include collapse or amount of bleeding in
ultrasound and/or fluoroscopy. pleural space
3. Assemble drainage system.
4. Reassure the patient and explain the  The patient can cope by
steps of the procedure. Tell the patient to remaining immobile and doing
expect a needle prick and a sensation of relaxed breathing during tube
slight pressure during infiltration insertion.
anesthesia.
5. Position the patient as for an intercostal  The tube insertion site depends
nerve block, or according to physician on the substance to be drained,
preference. the patient’s mobility, and the
presence/absence of coexisting
conditions.
Performance Phase
Hemostat Technique Using a Large-Bore Chest Tube
A large bore chest tube is used to drain blood or thick effusion from the pleural space
1. After skin preparation and anesthetic  The skin incision is usually made
infiltration, an incision is made through one interspace below proposed
the skin and subcutaneous tissue. site of penetration of the
intercostal muscles and pleura
2. A curved hemostat is inserted into the  To make a tissue tract for the
pleural cavity and the tissue is spread chest tube.
with a clamp.
3. The tract is explored with a examining  Digital examination helps confirm
finger. the presence of the tract and
penetration of the pleural cavity.
4. The tube is held by the hemostat and
directed through the opening up over the
ribs and into the pleural cavity
5. The clamp is withdrawn and the chest  The chest tube has multiple
tube is connected to a drainage system. openings at the proximal end for
drainage of air/blood.
6. The tube is sutured in place and covered  To make a tissue tract for the
with a sterile dressing chest tube.
Follow-up Phase
1. Observe the drainage system for  If a hemothorax is draining
blood/air. Observe for fluctuation in the through a thoracostomy tube into
tube on respiration. a bottle containing sterile normal
saline, the blood is available for
autotransfusion.
2. Secure a follow-up chest x-ray  To confirm correct chest tube
placement and reexpansion of the
lung.
3. Assess for bleeding, infection, leakage of
air and fluid around the tube.
Managing the Patient with Water-Seal Drainage
Nursing Action Rationale
Performance Phase
1. Attach the drainage tube from the  Water-seal drainage provides for the
pleural space (the patient) to the escape of air and fluid into the
tubing that leads to a long tube with drainage bottle. The water acts as a
end submerged in sterile normal seal and keeps the air from being
saline. drawn back into the pleural space.
2. Check the tube connections  Tube connections are checked to
periodically. Tape if necessary. ensure tight fit and patency of the
tubes.
a. The tube should be approximately  If the tube is submerged too deep
1 inch below the water level below the water level, a higher
intrapleural pressure is required to
expel air.
b. The short tube is left open to the  Venting the short glass tube lets air
atmosphere escape from the bottle.
3. Mark the original fluid level with tape  This marking will show the amount of
outside of the drainage bottle. Mark fluid loss and how fast fluid is
hourly/daily increments at the collecting in the drainage bottle. It
drainage level serves as a basis for blood
replacement, if the fluid is blood.
Gross bloody drainage will appear in
the bottle in the immediate
postoperative period and, if
excessive, may necessitate
reoperation. Drainage usually
declines progressively after first 24
hours.
4. Make sure the tubing does not loop or  Fluid collecting in the department
interfere with the movements of the segment of the tubing will decrease
patient. the negative pressure applied to the
catheter. Kinking, looping, or
pressure on the drainage tubing can
produce back pressure, thus
possibly forcing drainage back into
the pleural space or impending
drainage from the pleural space.
5. Encourage the patient to assume the  The patient's position should be
position of comfort. Encourage good changed frequently to promote
body alignment. When the patient is in drainage and body kept in good
a lateral position, placed a rolled towel alignment to prevent postural
under the tubing to protect it from the deformity and contractures. Proper
weight of the patient’s body. positioning helps breathing and
Encourage the patient to change promotes better air exchange. Pain
position quickly. medication may be indicated to
enhance comfort and deep
breathing.
6. Put the arm and shoulder at the  Exercise helps to avoid ankylosis of
affected side through range-of-motion the shoulder and assist
exercises several times daily. Some
pain medication may be necessary.
7. “Milk” the tubing in the direction of the  “Milking” the tubing prevents it from
drainage bottle as often as ordered. becoming plugged with clots of fibrin.
(Many institutions do not advocate Constant attention to maintaining the
“milking” because of the increased patency of the tube will facilitate
intrapleural pressure it causes). prompt expansion of the lung and
minimize complications.
8. Make sure there is fluctuation  Fluctuation of the water level in the
“tidaling” of the fluid level in the long tube shows that there is effective
glass tube. communication between the pleural
 space and the drainage bottle;
provides a valuable indication of the
patency of the drainage system, and
is,a gauge of intrapleural pressure.
9. Fluctuations in the tubing will stop
when:
a. The lung has reexpanded
b. The tubing is obstructed by
blood clots or fibrin
c. A dependent loop develops
d. Suction motor or wall suction is
not operating properly
10. Watch for leaks of air in the drainage  Leaking and trapping of air in the
system as indicated by constant pleural space can result in tension
bubbling in the water-sealed bottle. pneumothorax.
a. Report excessive bubbling in
the water-seal change
immediately
b. “Milking” of chest tubes in
patients with air leaks should
be done only if requested by
surgeon
11. Observe and report immediately  Many clinical conditions may cause
signs of rapid, shallow breathing, these signs and symptoms, including
cyanosis, pressure in the chest, tension pneumothorax, mediastinal
subcutaneous emphysema, or shift, hemorrhage, severe incisional
symptoms of hemorrhage. pain, pulmonary embolus, and
cardiac tamponade. Surgical
intervention may be necessary.
12. Encourage the patient to breathe  Deep breathing and coughing help to
deeply and cough at frequent raise the intrapleural pressure, which
intervals. If there are signs of allows emptying of the accumulation
incisional pain, adequate pain in the pleural space and removes
medication is indicated secretions
13. If the patient has to be transported to  The drainage apparatus must be
another area, place the drainage kept at a level lower than the
bottle below the chest level (as close patient’s chest to prevent backflow of
to the floor below as possible) fluid into the pleural space.
14. If the tube becomes disconnected,
cut off the contaminated tips of the
chest tube and tubing, insert a sterile
connector in the chest tube and
tubing, and reattach to the drainage
system. Otherwise, do not clamp the
chest tube during transport.
15. When assisting the removal of the  The chest tube is removed as
tube: directed when the lung is
a. Administer pain medication 30 reexpanded (usually 24 hours to
minutes before removal of several days) during the tube
chest tube removal, avoid a large sudden
b. Instruct the patient to perform a inspiratory effort, which may provide
gentle Valsalva maneuver or to pneumothorax.
breathe quietly
c. The chest tube is clamped and
removed
d. Simultaneously, a small
bandage is applied and made
airtight with gauze sealed with
tape