Indications
Remove fluid, air, or blood
Hemothorax
Remove blood
Pneumothorax
Remove air
Pleural Effusion
Remove Fluid
Chest Tubes
The Chambers
3 Chambers
Suction Control Chamber
When suction is applied by connecting it to the wall suction, there should be continuous gentle bubbling in the suction control chamber. The chest tube can also be to “water seal,” meaning that it is not connected to suction.
Water Seal Chamber
Serves as a one-way valve to prevent air from entering the pleural cavity. When the client breathes, air, blood, or fluid exit the pleural cavity and the water seal prevents it from re-entering the pleural space.
Fluid Collection Chamber
Collects drainage from the pleural space
How do you know it's working...
- Tidaling in the water seal is normal. Water moves up on inspiration and down on expiration. To remember, take a deep breath and note that your chest moves up. Now exhale and your chest will move down.Â
- There should be no bubbling in the water seal. If bubbling present=air leak. However, I have seen questions in Saunders that intermittent bubbling in the water seal is normal if the client has a pneumothorax. Only intermittent bubbling and not continuous!
- Bubbling in the suction control chamber is ok when connected to suction
- NCLEX alert: In pneumonia, the client will have bronchial breath sounds at the bases.
Nursing Implications
- Tape all connections to prevent disconnections
- Never clamp chest tube, not even during transport. NCLEX alert
- No vigorous stripping
- Change chest drainage system when half full.
- Removal critera: 50 ml/day of chest tube output
- Removal critera: chest xray shows problem resolved or no fluctuation in the water seal when no suction is applied.
- To remove: client exhales and holds it (Valsalva maneuver) which creates intrathoracic pressure to prevent air from entering pleural cavity. Xray post removal is the number 1 priority to check for pneumothoraxÂ