Plus-Hex CLINICAL
Nursing care, management and treatment
Management of thoracostomy tubes
Patients with thoracostomy tubes require careful management and monitoring for complications [ 6 ]. Common complications that can arise include:
• Dislodgement or inadvertent removal of the tube
• Subcutaneous emphysema
• Iatrogenic pneumothorax
• Drain malpositioning
• Drain obstruction
• Infection
• Pain.
It is essential to ensure safe and correct use of the thoracostomy tube. Appropriate hand hygiene and aseptic technique should be used during handling to reduce the risk of ascending infection around the tube insertion site [ 6 ]. The insertion site should be covered with an adhesive sterile dressing; some dressings will allow direct visualisation of the insertion site while still providing protection [ 6 ].
Patient comfort can be improved by applying padding around the thoracostomy tube site and securing the tube to the body wall using an appropriate dressing. A suitably placed dressing combined with an Elizabethan collar is often sufficient to prevent patient interference [ 6 ].
that allows evacuation of air from the pleural space while preventing air re-entry [ 8 ]. To maintain the water seal, the chamber must be adequately filled and must remain upright [ 8 ]. The saline in the water-seal chamber should rise and fall with inhalation and exhalation; this is sometimes referred to as‘ tidalling’. Tidalling indicates that the thoracostomy tube is patent [ 8 ]. Air leakage into the pleural space can be detected by observing bubbling in the water-seal chamber; this would be expected for a patient with pneumothorax [ 7 ]. In some cases, the water-seal chamber alone is sufficient for effective drainage [ 8 ].
• The suction chamber controls the amount of negative pressure being applied to the pleural space [ 7 ]. Some cases require additional suction to facilitate accelerated drainage and lung re-expansion [ 8 ]. The suction control chamber contains a rigid straw, similar to that in the water-seal chamber, and this chamber is also filled with sterile saline. The amount of negative pressure generated within the suction system is equivalent to the depth of immersion of the rigid straw beneath the surface of the saline [ 8 ]. The device aims to simulate normal intrapleural pressure while continuously aspirating any air leaks that are present [ 1 ]. A suction pressure of 10 – 15 cmH 2
O is suitable for air evacuation [ 7 ]. Gentle bubbling should be observed in the suction chamber when suction is applied. Excessive suction can lead to increased air leakage, patient discomfort and water evaporation, which can lead to inadequate suction pressure; therefore, it must be applied conservatively [ 8 ].
Thoracic drainage via a thoracostomy tube is often performed intermittently, either at specified intervals or as required if the patient displays signs of respiratory compromise [ 7 ]. Significant leaks from the pulmonary parenchyma can be difficult to manage efficiently, particularly when continuous drainage is required. In these cases, a three-chamber water-sealed thoracic drainage system may be used, such as the Argyle Thora-Seal III unit( Cardinal Health)( Figure 2).
The system is constructed of three chambers: a fluid collection chamber, a suction chamber and a water-seal chamber [ 8 ].
• The fluid collection chamber allows for quantification of the volume and type of fluid drained from the pleural space.
• The water-seal chamber contains a rigid tube that connects the system to the patient ' s thoracostomy tube. The water-seal chamber should be filled with sterile saline to the indicated level, which will partially immerse the other end of the rigid tube [ 8 ]. This chamber contains a one-way valve
Figure 2. An Argyle Thora-Seal III unit.
Volume 41( 5) • October 2026
33