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Chest tubes and underwater seal drains: Nursing management

CPD Hours



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Clinical practice and procedures


Chest drainage systems, including chest tubes and underwater seal drains, are used to manage the accumulations of air or fluid in the pleural cavity.

The use of these systems involves a multidisciplinary approach to patient care, advanced nursing knowledge, and frequent monitoring.

Inadequate management may lead to significant patient complications including pneumothorax, respiratory compromise, pain, and prolonged hospital stays. Practitioners caring for patients with chest drainage systems require an understanding of the underlying pathophysiology, principles of care, potential complications, and troubleshooting techniques.

This module is suitable for all registered or enrolled nurses working in acute inpatient settings, such as emergency departments, intensive care units, and medical and surgical wards.

This module has drawn on a number of key references and in particular the NSW Agency for Clinical Innovation. Consensus guideline: pleural drains in adults (2016). The Consensus Guideline offers guidance on competencies for clinicians and it is recommended that, in the absence of the availability of local competency and training materials, this document can be referred to.

Learning Objective

At the end of this module participants will be able to:

  • Explain the anatomy and physiology of the respiratory system as it relates to chest drainage systems and the pathophysiology that results in the need for a drain.
  • Know the principles of care of chest drainage systems including chest tube insertion, underwater seal drain set up, and maintenance.
  • Understand the complications of chest tubes.
  • Troubleshoot complications.
  • Know the nurse’s role in providing care for a patient with chest tubes.

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