What does it mean when a chest tube stops bubbling?
Chapter 10. Tubes and Devices Show
A chest tube, also known as a thoracic catheter, is a sterile tube with a number of drainage holes inserted into the pleural space (see Figure 10.8). The pleural space is the space between the parietal and visceral pleura, and is also known as the pleural cavity (see Figures 10.9). A patient may require a chest drainage system any time the negative pressure in the pleural cavity is disrupted and causes respiratory distress. Negative pressure is disrupted when air, or fluid and air, enters the pleural space and separates the visceral pleura from the parietal pleura, preventing the lung from fully expanding and collapsing. Small amounts of fluid or air accumulating in the pleural space are often absorbed by the body without a chest tube. Figure 10.10 demonstrates a pneumothorax. A large amount of fluid or air cannot be absorbed by the body and will require a drainage system in order to optimize oxygenation (Bauman & Handley, 2011; Perry et al., 2018). Another type of chest tube called a Heimlich valve is discussed later in this chapter.
The location of the chest tube depends on what is being drained from the pleural cavity. If air is in the pleural space, the chest tube will be inserted above the second intercostal space at the mid-clavical line. If there is fluid in the pleural space, the chest tube is inserted at the fourth to fifth intercostal space, at the mid-axillary line. A chest tube may also be inserted to drain the pericardial sac after open heart surgery. These tubes are placed directly under the sternum and are referred to as mediastinal chest tubes (Perry et al., 2018). Some conditions that may require a chest tube drainage system include (Bauman & Handley, 2011; Perry et al., 2018):
Chest Tube Drainage SystemsA chest tube is connected to a closed chest drainage system, which allows for air or fluid to be drained and prevents air or fluid from entering the pleural space. Because the pleural cavity normally has negative pressure, which allows for lung inflation and deflation, any tube connected to it must be sealed so that air or liquid cannot enter the space where the tube is inserted (Bauman & Handley, 2011; Rajan, 2013). In a chest drainage system, a water seal provides that protection. Chest tube drainage systems are sterile and disposable and consist of either two or three compartments (see Figure 10.11). The traditional chest drainage system typically has three chambers (Bauman & Handley, 2011; Rajan, 2013). Figure 10.12 illustrates how a chest drainage system works. Note how the three chambers are connected and the path that air (pneumothorax) or blood (hemothorax) would take if the chest tube were attached to such a system. Figure 10.11 Chest tube drainage system with labelsFigure 10.12 Under water seal drainage systemAlways review what type of system is used in your agency, and follow the agency’s and the manufacturer’s directions for setup, monitoring, and use. An explanation of the different chambers in is order:
In addition to the three chambers, the drainage system has many safety features to ensure that high negative pressures can be monitored and relieved quickly. To review these safety features and additional information regarding the chambers of a closed chest tube drainage system, visit the Teleflex Medical Incorporated website. Sometimes the prescriber will order a chest tube attached to suction to facilitate rapid drainage. In this case, the amount of suction should be prescribed. Chest drainage systems designs include dry suction systems and wet suction systems. Table 10.4 outlines the key differences between dry and wet suction units.
Table 10.5 provides a list of potential complications and interventions related to chest tube drainage systems.
Checklist 88 reviews the care and management of a person with a closed chest tube drainage system
Special considerations:
Watch the video Chest Tubes – Care and Maintenance by Kirstin McLaughlin and Wendy McKenzie, Thompson Rivers University (2019) Heimlich ValveA Heimlich valve (see Figures 10.13 and 10.14) is a small, specially designed flutter valve that is portable and mobile, allowing the patient to ambulate with ease. It attaches to the chest tube at one end and a drainage bag at the other. The valve can be worn under clothing. The valve functions in any position, never needs to be clamped, and can be hooked up to suction if required (Gogakos et al., 2015). Figure 10.15 illustrates how air entering the valve from the patient opens the sleeve to allow air to escape the patient’s pleural space. The sleeve collapses preventing the back flow of air back into the patient. Critical Thinking Exercises
AttributionsFigure 10.8. Chest tube drainage holes in a variety of chest tubes by Bentplate84 is used under a CC BY-SA 3.0 license. Figure 10.9. Parietal and Visceral Pleurae of the Lungs from OpenStax College, Anatomy & Physiology. Used under a CC BY 3.0 license. Download for free at http://cnx.org/contents/. Figure 10.10. Pneumothorax by Blausen.com staff is used under a CC BY 3.0 license. Figure 10.11.Chest tube drainage system from BCIT is used under a CC BY-SA 4.0 international license. Figure 10.12. Adapted from GrepMed, n.d.; Chung, n.d.; Salmon, Lynch & Muck, 2013, by author. Figure 10.13 & 10.14 Heimlich Valve from BCIT is used under a CC BY-SA 4.0 international license. Figure 10.15. Line diagram of Heimlich Valve (Flutter Valve) including mechanism for one-way airflow by Orinoco-w is used under a CC BY-SA 3.0 license. What happens when a chest drain stops bubbling?If the lung has not reinflated but there is no bubbling in the underwater bottle, then the tube is blocked or kinked-this can be corrected; or else the tube has become displaced-a replacement must be inserted through a clean incision.
Why would a chest tube stop Tidaling?If tidaling doesn't occur, the tubing could be kinked or clamped, or a dependent tubing section may have become clogged with fluid buildup (Bauman & Handley, 2011). While the chest tube is in place, the physician may order tests on the pleural fluid for various reasons.
Should there be continuous bubbling in a chest tube?Continuous bubbling of this chamber indicates large air leak between the drain and the patient. Check drain for disconnection, dislodgement and loose connection, and assess patient condition. Notify medical staff immediately if problem cannot be remedied.
What does a lack of bubbling in the UWD indicate?If bubbling ceases during initial clamp, check insertion site as drainage eyelets may be outside of body or stab wound is too large.
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