Atrium Dry Suction Chest Drainage
Set-up
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Remove chest tube drainage set up from package
Fill Water Seal “air leak” monitor/indicator to the 2 cm fill line with the prefilled 45 mL sterile water
(attached to back of chest drain) through the suction port
o Once filled, water becomes tinted blue for improved visibility of air leaks and convenient
monitoring of patient pressures
o Connect chest drain to patient prior to initiating suction
o Connect suction tubing blue suction port on top of chest drain
o Connect other end of suction tubing to Ohio wall suction
o Turn Ohio suction regulator on to continuous suction at -80 mmHg or higher
o Dial centimeters of suction ordered by turning suction control regulator on drainage system
to desired level (preset at -20 cmH2O)
o Verify suction operation via the suction monitor bellows
o Orange suction bellows must be expanded to Δ mark or beyond for a -20
cmH2O or higher regulator setting
o If suction setting is ordered at < -20 cmH2O, bellows do not need to be fully
expanded
o If chest tube is ordered “to water seal” or “to gravity” disconnect suction
tubing from drainage system
o Always position drainage collection chamber below patient’s chest in an upright position
to prevent backflow of fluid into lungs, pericardial or pleural space.
o Secure chest tube connections per physician preference
o Label Ohio suction head as “chest tube - do not turn off”
o Keep chest tube tubing free of kinks and dependent loops
Nursing Responsibilities
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Amount and color of chest tube drainage will be documented in the electronic record (Intake and
Output section) every 8 hours at the beginning of each shift
o Output will be monitored by drawing line at level of drainage on the drainage collection
system indicating date, time, and initials
Ongoing assessment will be made of water chamber
o Air leaks will be documented and reported to physician. An air leak is present/confirmed
when air bubbles are observed going from right to left in the air leak monitor.
o Assess severity of air leak by looking at the air leak graduated monitor. Range is from 1
(low) to 5 (high). Document air leaks. (ex: Rt pleural CT 20 cm sx + 3 continuous air leak
noted)
 Continuous bubbling in the bottom of the water seal air leak monitor will confirm a
persistent air leak
 Intermittent bubbling in the air leak monitor with float ball oscillation will confirm
the presence of an intermittent air leak
 No bubbling with minimal float ball oscillation at bottom of the water seal will
indicate no air leak is present
o If new air leak noted, check all chest tube connections and secure as needed. Reassess,
notify physician, and document
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Assessment of Water Seal Column
o Tidaling (patient pressure float ball fluctuates up and down): This reflects pressure
changes in the chest with breathing. The ball rises during patient inspiration and lowers
during expiration. When the air leak is resolved, tidaling in the water seal column may be
observed. Tidaling is not evidence of an air leak.
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Ongoing assessment will be made regarding chest tube dressing
o Change chest tube dressing every 24 hours or more often if loose or soiled
 Record date and time of dressing change on dressing and in nursing documentation
 Dress CT site with 4x4s between CT and pt skin, 4x4s over CT, then tape (no
vaseline gauze)
o Any drainage on dressing will be circled and date and time marked on dressing
o Documentation needs to be present in nurses’ notes regarding chest tube dressing
o Assess insertion site and surrounding skin for presence of subcutaneous emphysema
(crepitus) and signs of infection or inflammation daily and with each dressing change
Changing suction pressures – adjust rotary suction regulator dial located on the side of the drain
o When adjusting regulator down to a lower setting, make adjustment and then temporarily
depress the manual high negativity vent located on top of the drain to reduce excess
vacuum
 During normal respiration a negative pressure (or vacuum) is always present
keeping the visceral and parietal pleurae together. When a CT is within this space
and we lower the amount of suction, we also need to lower the patient pressure (or
vacuum) by depressing the manual high negativity vent. This helps to assist the
lung since the CT is in a place with usual negative pressure which keeps the elastic
lung in an expanded position.
(*do not use manual vent when suction is not operating or when patient is on gravity drainage
because the lungs will control the amount of negative pressure)
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Sampling patient drainage
o Samples may be taken from needleless luer port on the patient tube connector. Alcohol
swab the luer port prior to syringe attachment
o Samples may also be taken directly from the patient tube by forming a temporary
dependent loop, alcohol swab the selected tube area, and insert a 20 gauge needle at an
oblique/shallow angle (DO NOT puncture patient tube with an 18 gauge or larger needle)