Illustration of basic chest tube collection device

CHEST TUBE BASICS[edit | edit source]

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

Discussion[View | Edit]

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