Concepts on
Oxygenation
Chest tubes &
Water seal
Drainage
Indications for Chest tube
drainage
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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
 Mesothelioma is a rare form of cancer that
develops from the protective lining that
covers many of the body's internal organs
Its most common site is the pleura
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
Drainage
Principles Involved
 Gravity
 positive pressure
 Suction
 Water – seal principle
TYPES OF CHEST
TUBE DRAINAGE
SYSTEM
1. SINGLE – BOTTLE
WATER SEAL
SYSTEM
2. TWO – BOTTLE
 The end of the
drainage tube from the
patient’s chest is covered by a
layer of water , which permits
drainage of air & fluid from the
pleural space , but does not
allow air to move back into the
chest .
 Functionally , drainage
depends on gravity , on the
mechanism of resopiration , & if
desired , on suction by addition
of controlled vacuum
 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
WATER SEAL
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