A chest tube is a flexible plastic tube, is inserted through the chest wall into the pleural space or mediastinum through the doctor
Types of Chest Tube Drainage
- One Bottle Chest Drainage System
- Two Bottle Chest Drainage System
- Three Bottle Chest Drainage System
One Bottle Chest Drainage System
This is one bottle collects the fluid and the same time seals air leak ( water seal is barrier). A rigid straw is immersed into the bottle, tip is located 2 cm below the surface of normal saline solution into the bottle.
The other end of this rigid straw is connected to the pleural cavity of thoracic drainage tube. Decompression valve which decompress the pressure from the air leak, an opening of one-way decompression valve. It is mportant to remove this valve cover before connecting the system to the client side.
When the pleural pressure is positive, the rigid straw pressure becomes positive, and if the positive pressure in straw is greater than the depth to which the tube is immersed in the saline solution, then air will enter in the bottle and then depressurized by vent into the atmosphere.
If the pleural pressure is negative, it would move liquid from the bottle to the rigid straw and air would not be entered in the pleural cavity or the rigid straw. This system is called water seal because the water bottle seals the pleural cavity from the air or liquid from the outside of the body.
It just like a straw in a drink, air can push through the straw, but air can not be drawn back up the straw.
when the rigid straw is above the liquid level in the bottle, the system would not be operated consistently developing pneumothorax.
However, when a significant quantity of liquid would be drained from the pleural cavity of the client, the liquid level would be rose, thus requiring a greater pressure on the rigid straw to remove effectively additional air from the pleural cavity to the bottle.
Practically, this system works when air is leaving the chest, because if fluid is draining, it would be added to the fluid in the water seal, it increase the depth, and as the depth increases, it becomes harder for the air to push through a higher level of water, could result in air stays in the chest. As a result, the one-bottle system works efficiently for uncomplicated pneumothorax.
Disadvantage of this system is that the position of the bottle at a level higher than the client’s chest causes liquid passing into the pleural cavity.
Two Bottle Chest Drainage System
The two-compartment system is preferred when large quantities of liquid are drained from the pleural cavity. In this system, the first bottle (closer to the patient) collects the drainage from client’s chest and the second bottle is the water seal, which remains at 2 cm (water seal and air vent).
The water-seal bottle is includes a place for drainage to collect and a one-way valve that prevents air or fluid returns to the chest. Both the bottles of chest drainage systems rely on gravity, which create a pressure gradient, by which air and fluid leave the chest.
Chest enhances gravity keep the drainage system below the level. Additional pressure is created when the client exhales or coughs.
If the client has a large air leak into the pleural space, gravity drainage may not be sufficient to evacuate the chest and suction may be required. This also means the addition of a third bottle to the system—a suction control bottle.
Three Bottle Chest Drainage System
In 1967, Deknatel is introduced the first integrated disposable chest drainage unit based on the three bottle system. The main approach was at this time that suction was always required to pull air and fluid out of the pleural space and pull the lung up against the parietal pleura. If suction is required, a third bottle is added.
However, recent research has shown that suction may actually prolong air leaks from the lung by pulling air through the opening that would otherwise close on its own.
The first chambers of the unit tubing connects the drainage unit directly to the chest tube, drainage flows into this chamber. The collection chamber has to be calibrated and has a easy measurement and recording of the time, date, and amount of drainage.
The middle chamber of chest drainage system is the water seal. The main purpose of the water seal is to allow air to exit from the pleural space on exhalation and it prevent air from entering the pleural cavity or mediastinum on inhalation.
When the water seal chamber is filled with sterile fluid up to the 2 cm line, to maintain an effective seal, it is important to keep the chest drainage unit upright at all times and to monitor the water level in the water seal to check for evaporation.
Sometimes negative pressure is necessary to apply in the pleural cavity in order to facilitate re-expansion of the underlying lung parenchyma or accelerate air removal from the pleural cavity.
The addition of a third bottle, it allows the controlled application of suction. A suction control bottle is connected to the water seal bottle. The two bottles are interconnected.
The suction control bottle has a rigid straw, which is similar to the water-seal bottle. The amount of negative pressure within the suction system is equal to the depth of immersion of the rigid straw below the liquid surface of the bottle. This size can be changed by adjusting the position of the rigid straw to the suction control bottle or by changing the depth of liquid in the bottle.
The uncontrolled suction have effects quite different to the expected results. Intensifying suction maximizes air leak, creates more noise, annoyance, discomfort, favours the evaporation of liquid from the control bottle and, as it exacerbates air leak, Bubbling in the water seal chamber which indicates an air leak.
The water seal chamber has a calibrated manometer to measure the amount of negative pressure within the pleural cavity. The as intra-pleural pressure becomes more negative when the water level in the small arm of the water seal rises
If there is not leaking of air, the water level would rise and fall with the client’s respirations, and it reflecting normal pressure changes would be in the pleural cavity. During spontaneous respirations, the water level would rise during inhalation and fall during exhalation.
In positive pressure ventilation, the oscillation would be just the opposite the water level, should fall with inhalation and rise with exhalation. This oscillation is called tidaling and it is an indicator of a patent pleural chest tube.
Some units of system have an anti-siphoning float valve in the water seal fluid column which prevents the water from being siphoned out of the water seal chamber and into the collection chamber during situations which create high negative pressures, such as chest tube stripping.
At the top of the chamber system is having the float valve which permits uncontrolled vacuum levels to accumulate in the client’s chest with each subsequent stripping of the client tube. To eliminate this pressure, system is having manual high negative pressure relief valves to chest drain system which allow filtered atmospheric air to enter the system to prevent any accumulation of negative pressure in the client.
Three situations can cause high negative pressure
- Respiratory distress, coughing vigorously, or crying;
- Chest tube stripping; Decreasing or disconnecting suction.
- Vigorous milking or stripping can create dangerously high negative pressures.