Chest Tube Management Case Study (60 min)

Mr. Jones is a 19 year old male who was in a motor vehicle collision yesterday. He sustained a fractured left radius and fractures to ribs 4-7 on the left side.  He was admitted to the trauma med-surg floor last night. This morning, he suddenly develops shortness of breath and ‘chest tightness’. He says “I feel like I can’t get a deep breath” and appears very anxious.

You assess Mr. Jones to find his SpO2 is 90%, his RR is 32, HR 108, and BP 117/72. You auscultate his lungs but find that lung sounds are diminished and almost absent over the left upper lobe.

You notify the provider who orders a STAT Chest x-ray.  The chest X-ray confirms the patient has a moderate sized pneumothorax on the left side, with no shifting of the mediastinum or trachea. The provider determines the patient needs a chest tube placed. You gather supplies, set up the drainage system and assist with placement of the chest tube on the left side.

You secure the chest tube with an occlusive dressing and place the drainage system at the foot of the bed. The provider orders the chest tube to be placed to water seal, without suction.

You note intermittent bubbling in the air leak chamber and no output in the drainage chamber. The patient’s lungs sound clear, though still slightly diminished in the left upper lobe. SpO2 is has risen to 96% on 2L nasal cannula.  Four hours later, you are checking the chest tube system again and notice continuous bubbling in the air leak chamber.

You notice the connections had come loose, so you tighten them, which fixes the air leak.  Later that evening when turning the patient, the chest tube becomes accidentally dislodged from the patient’s chest.

Mr. Jones remained stable even without the chest tube, therefore the provider decided that his pneumothorax had resolved and there was no need to replace it. You continue to monitor for any possible complications or redevelopment of a new pneumothorax.