CHEST TUBE BASICS[edit | edit source]

Illustration of basic chest tube collection device

Common terms related to types of drainage[edit | edit source]

  • Sanguineous- is fresh thick blood.
  • Serosanguineous- is thin, like water. It usually has a light red or pink tinge, though it may look clear in some cases. Its appearance depends on how much clotted red blood is mixed with serum.
  • Serous- a clear to pale yellow watery fluid
  • Chylous – has a milk like appearance. Chylothorax is a rare condition in which lymph formed in the digestive system (chyle) accumulates in your chest cavity. Lymph is a fluid containing white blood cells and proteins that moves through your lymphatic system and drains into your bloodstream

Trouble Shooting[edit | edit source]

  • Accidental removal
    • Occlude the site ASAP!
    • Cover the hole with a gloved hand until you can apply Vaseline gauze/dry gauze/tegaderm
    • This is where your emergency chest tube kit comes in handy
  • Get a STAT Chest X-ray
  • Watch for signs of pneumothorax
  • Respiratory Distress
    • Consider O2 support if needed
    • Surgery will decide if need to be replaced
  • Airleaks
  • Water Seal Chamber
    • Acts as one-way valve so air can get out of the chest, but not back in
    • Fluctuations in the water level and bubbling provides an indication of intrathoracic pressure
    • The water in the water-seal chamber should rise with inhalation and fall with exhalation (this is called tidaling)
    • Bubbling in chamber in this chamber is called an “air-leak” and indicates either evacuation of air from the chest or a leak in the system
    • Continuous bubbling in the bottom of the water-seal chamber from right to left should lead to suspicion of an air leak in system
  • Location
    • Is the air coming from the patient or from a crack in the system?
    • Clamp CT close to the patient if no air leak in water seal chamber, then patient is evacuating air from chest
    • May have flute or fenestration outside pleural cavity (may cause noise)
    • Clamp CT close to patient, if air leak still present in water seal chamber- air is coming from a crack in the system
    • Try replacing the Atrium
    • Air leaks are often more apparent when a patient coughs
  • Chest tube removal supplies and how to (usually by MD)
    • Assess for air leak
    • Remove from suction
    • Prepare dressings (Vaseline gauze, standard gauze, tegaderm)
    • Remove old dressing
    • Remove anchor suture (typically a black suture)
    • If purse string is present (typically a white suture), ensure both ends are free and suture is intact
    • Cover exit site with Vaseline gauze and standard gauze
    • Chest tubes should be removed at the end of inspiration or beginning of expiration to avoid sucking air into the chest
    • Remove chest tube quickly at end of inspiration or expiration.
    • Keep exit site covered
    • Tie down purse-string suture (if present) without pulling too tightly (to avoid tissue necrosis)
    • Obtain a CXR ~1hr post chest tube removal – order sooner if patient becomes clinically unstable
Page data
Part of Cardiac Surgical Skills Training Module
Keywords surgery, cardiology, Medical knowledge pages
SDG Sustainable Development Goals SDG03 Good health and well-being
Authors Owen Robinson
Published 2021
License CC-BY-SA-4.0
Affiliations Global Surgical Training Challenge
Language English (en)
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