What activities can the licensed practical nurse perform when caring for a patient with a chest tube?

It is within the scope of practice of the appropriately prepared and competent licensed practical nurse to perform the following tasks related to chest tube care under the direction of an authorized health care practitioner, or under the direction and supervision of the registered nurse, following clinical practice standards:

• Chest tube insertion site and dressing change.
• Clamp the tube in an emergency.
• Administer medications via a chest tube.
• Monitor patency of the draining system.
• Assist an authorized health care practitioner or the registered nurse in removing a chest tube.
• Changing bottles and/or disposable collection system.

It is not within the scope of the licensed practical nurse to perform the following tasks:

• Independently remove a chest tube.
• Manipulate, advance, irrigate, milk, or remove a chest tube.

The licensed practical nurse must demonstrate the following competencies:

• Demonstrate knowledge and ability to apply critical thinking and evidence-informed inquiry throughout the nursing process to care for a patient with a chest draining system.
• Demonstrate knowledge and understanding of the indications and contraindications for chest tube insertion.
  • Hemothorax
  • Spontaneous or traumatic pneumothorax
  • Tension pneumothorax
  • Spontaneous or traumatic pneumothorax
  • Tension pneumothorax
  • Pleural effusion
  • Cardiac tamponade
  • Diaphragmatic hernia
  • Hepatic hydryothorax
  • Refractory coagulopathy
• Demonstrate knowledge and ability to identify and describe purpose of pleural or mediastinal chest tubes.
• Demonstrate knowledge and ability to assist with insertion and removal of chest tubes
• Demonstrate knowledge and ability to setup, manage, and access a chest tube system.
• Demonstrate knowledge and ability to identify potential complications for patients with chest drainage systems such as:
  • Compromise in system patency
  • Discussion or malfunction
  • Incorrect placement, dislodgement, or occlusion
  • Hemorrhage
  • Pulmonary Edema
  • Infection
  • Subcutaneous emphysema

The licensed practical nurse should use the Nursing Scope of Practice Decision Tree  to determine if these activities are within the nurse’s legal and individual scope of practice.