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Managing a Chest Tube and Drainage System
RAJARAMAN DURAI, MD, MRCS; HAPPY HOQUE, FRCS; TONY W. DAVIES, FRCS
February 2010 Vol 91 No 2 DURAIHOQUEDAVIES
Figure 1. Chest x-ray, showing a pleural effusion on the left side.
container, which is a closed drainage system, requires a different approach. The water-seal chamber allows only one-way movement: air and liquid can escape from the pleural cavity but cannot ow inthe reverse direction. Managing a chest tube requires monitoring the chest-tube position and controlling uid evacuation. The water-seal chamber should not be emptied unless the drainage container is full.
Some health care facilities allow trained nurses to remove chest tubes1 but not all nurses are familiar with this procedure,2 and there is not sufcient published research describing the nursing management of chest tubes.3 This article provides information for nurses about chest tubes and their management.
INDICATIONS FOR A CHEST TUBE
The potential space around the lungs is called the pleural cavity. Under normal conditions, the pleural cavity is maintained by negative pressure, which is important for ensuring lung expansion with deep inspiration. When blood (ie, hemothorax),4 air (ie, pneumothorax),5 pus (ie, pyothorax),6 or lymph (ie, chylothorax)7 collects in the pleural cavity, negative pressure is lost and lung expansion is restricted. The chest-tube drain allows uid or air to drain from the pleural cavity. As a result of the negative pressure, however, the air may preferentially enter the pleural cavity, particularly if the size of the chest-wall de-
fect or the chest tube is larger than the size of the trachea.
Whenever the pleural cavity is drained by a chest tube, whether it is for blood, air, pus, or lymph, the tube should be connected to a water-seal drainage container so that air is not inadvertently sucked into the chest. The water-seal drainage container normally is lled with approximately 375 mL of sterile water to the marked level.
In years past, a series of up to three reusable glass bottles were connected to one another and attached to the chest tube. Currently, clear plastic disposable containers are used instead. They consist of either a single chamber with an underwater seal (Figure 2) or a three-chamber container with a
collection chamber,
suction chamber, and
water-seal chamber in the middle...