Hemothorax

Definition

Hemothorax is the collection of blood in the pleural space, usually from chest trauma, surgery, or vascular rupture. Large accumulations compress the lung and impair ventilation.

Signs and Symptoms

• Dyspnea, tachypnea
• Decreased or absent breath sounds on affected side
• Dullness to percussion
• Tachycardia, hypotension
• Hypoxia
• Tracheal deviation (massive hemothorax)

Management

Chest tube insertion with wide-bore drain in the 5th intercostal space at midaxillary line. Connect to a 3-chamber drainage system. Surgical exploration if drainage exceeds 1500 mL initially or more than 200 mL/hour × 2 to 4 hours.

Nursing Care

• Monitor drainage amount, color, rate. Report sudden cessation (possible kink or clot)
• Keep chamber below chest level
• Tidaling in water seal chamber indicates patency
• Continuous bubbling in water seal = air leak
• Never clamp chest tube without order (pneumothorax risk)

NCLEX Relevance

Chest tube management is high-yield; recognize tension pneumothorax and hemothorax cues.