Concepts on Oxygenation

Chest tubes & Water seal Drainage

Indications for Chest tube drainage

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

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 contd.

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
WATER SEAL SYSTEM
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

The end of the drainage tube from the patients 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

3. THREE- BOTTLE WATER SEAL SYSTEM Theres 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