Pleural Effusion and Chest Tubes

A pleural effusion is excess fluid between the visceral and parietal pleura. A chest tube, or intercostal drain, removes pleural air, blood, pus or fluid and allows the lung to re-expand. These are not simply “fluid balance” and “tubing” topics. They are respiratory assessment problems in which a small change in drainage, breath sounds or oxygenation can signal either recovery or a life-threatening complication. The pleural space normally contains only a very small amount of lubricating fluid—approximately 0.1–0.2 mL/kg on each side. Fluid enters mainly from capillaries in the parietal pleura and is cleared mainly through lymphatic stomata. An effusion forms when production outpaces lymphatic clearance. The experienced nurse starts with the patient, not the collection chamber: - Is the patient breathing comfortably, or has work of breathing increased? - Are oxygen saturation, respiratory rate, heart rate and blood pressure changing? - Is the chest moving symmetrically? - Is there new pain, cough, fever, confusion or cyanosis? - Does the drainage pattern fit the diagnosis and the patient’s current condition? A number on the drain is never interpreted in isolation.