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Chest Tube Insertion Technique

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Chest Tube Drainage System

Description

  • The chest tube drainage system returns negative pressure to the intrapleural space.
  • The system is used to remove abnormal accumulations of air and fluids from the pleural space.

Drainage collection chamber

  • The drainage collection chamber is located where the chest tube from the client connects to the system.
  • Drainage from the tube drains into and collects in a series of calibrated columns in this chamber.

 

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Water seal chamber

  • The tip of the tube is underwater, allowing fluid and air to drain from the pleural space and preventing air from entering the pleural space.
  • Water oscillates (moves up as the client inhales and moves down as the client exhales).
  • Excessive bubbling indicates an air leak in the chest tube system.

Suction control chamber

  • The suction control chamber provides the suction, which can be controlled to provide negative pressure to the chest.
  • This chamber is filled with various levels of water to achieve the desired level of suction; without this control, lung tissue could be sucked into the chest tube.
  • Gentle bubbling in this chamber indicates that there is suction and does not indicate that air is escaping from the pleural space.

Dry suction system

  • This is another type of a chest drainage system and because this is a dry suction system, absence of bubbling is noted in the suction control chamber.
  • A knob on the collection device is used to set the prescribed amount of suction; then the wall suction source dial is turned until a small orange floater valve appears in the window on the device
  • (when the orange floater valve is in the window, the correct amount of suction is applied).

Portable chest drainage system:

Small and portable chest drainage systems are also available and are dry systems that use a control flutter valve to prevent the backflow of air into the client’s lung; principles of gravity and pressure, and the nursing care involved are the same for all types of systems and these systems allow greater ambulation and allow the client to go home with the chest tubes in place.

Interventions

Collection chamber

  • Monitor drainage; notify the physician if drainageismore than70 to100mL/hror if drainage becomes bright red or increases suddenly.
  • Mark the chest tube drainage in the collection chamber at 1- to 4-hour intervals, using a piece of tape.

Water seal chamber

  • Monitor for fluctuation of the fluid level in the water seal chamber.
  • Fluctuation in the water seal chamber stops if the tube is obstructed, if a dependent loop exists, if the suction is not working properly, or if the lung has reexpanded.

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