Concepts on Concepts on OxygenationOxygenation

Chest tubes & Water seal Drainage

Indications for Chest tube drainage

To evacuate air or fluid from pleural space Pneumothorax > 20 % Hemothorax > 500cc Pneumohemothorax Pleural Effusion Fluid collections Mechanically ventilated patients with any size

pneumothorax or hemothorax

Indications for Chest tube Drainage

Respiratory distress or ventilator dependence that does not permit thoracentesis

Monitor ongoing air leak or blood loss

Contraindications

Coagulopathy or platelet dysfunction warrants caution

Known or suspected mesothelioma Pure tuberculosis effusion

Types & Purposes of Chest tubes

1. Pleural Tubes> the insertion

of pleural tube permits removal of the air or bloody fluid & allows for reexpansion of the lung and restoration of the normal negative pressure in the pleural space .

Types & Purposes of Chest Tubes cont’d.

2. Mediastinal tubes

> are placed to en -

sure that fluid does

not accumulate &

put pressure on the

heart but instead

drains to facilitate

healing

Chest Tube Size

French sizing refers to circumference in millimeters

Pure Pneumothorax : French 20 – 24 Fluid : French 28 tubes are recommended French 32 or larger tubes tend to cause too

much discomfort unless a rib resection is performed

Principles of Chest Principles of Chest DrainageDrainage

Principles Involved

Gravity positive pressure Suction Water – seal principle

TYPES OF CHEST TYPES OF CHEST TUBE DRAINAGE TUBE DRAINAGE

SYSTEMSYSTEM

1. SINGLE – BOTTLE WATER SEAL SYSTEM

The end of thedrainage tube from thepatient’s chest is covered by alayer of water , which permitsdrainage of air & fluid from the pleural space , but does not allow air to move back into the chest . Functionally , drainagedepends on gravity , on the mechanism of resopiration , & ifdesired , on suction by addition of controlled vacuum

2. TWO – BOTTLE WATER SEAL SYSTEM

consists of the same water – seal chamber , plus a fluid – collection bottle

Drainage is similar to that of a single unit , except that when pleural fluid drains , the underwater – seal system

is not affected by the volume of the drainage

Effective drainage depends on gravity or on the amount of suction added to the system

3. THREE- BOTTLE WATER SEAL SYSTEM There’s an addition of a 3rd

bottle to control the amount of suction applied

The amount of suction is determined by the depth to which the tip of the venting glass tube is submerged in the water

Drainage depends on the gravity or the amount of suction applied , which is controlled by the manometer

bottle The mechanical suction motor /

wall suction creates & maintains a negative pressure throughout the entire closed drainage system

4. PLEUR – EVAC WATER SEAL SYSTEM

Is a three- chambered system that utilizes the same basic principles as the classic three-bottle system