CHEST TUBE DRAINAGE

SYSTEM
Chest tube is a flexible plastic tube
that is inserted through the chest
wall and into the pleural space or
mediastinum.
Purpose: remove air in the case of
pneumothorax or fluid such as in the
case of pleural effusion, blood, chyle,
or pus when empyema occurs from
the intrathoracic space.
Aim for adequate chest drainage:
 remove fluid & air as promptly as possible
 prevent drained air & fluid from returning
to the pleural space
 restore negative pressure in the pleural
space to re-expand the lung

Requirement/terms for the drainage

device:
 allow air and fluid to leave the chest
 contain a one-way valve to prevent air &
fluid returning to the chest
 have design so that the device is below the
level of the chest tube for gravity drainage
Indication
Contraindication
 Absolute: lack of informed consent or
patient cooperation

 Relative: uncorrected coagulopathy and

instrumental access to the pleural cavity
without image-guidance in patients with
substantial pleuro-pulmonary adhesions
or multiloculation

 Warning: don’t insert chest tube in

infected skin area!
 BASIC
“Rely on gravity to create a pressure gradient
by which air and fluid leave the chest”
Keeping the drainage system below the level of the patient's chest enhances gravity drainage
 How does it works? the basic is one-bottle system
Consist:
 Bottle  collects & contains the fluid and
seals air leak (leakage barrier-water seal)
 Rigid straw is immersed into the bottle, its tip
is located 2 cm below the surface of the saline
solution, which is put into the bottle.
Rigid
straw The other end of this rigid straw is connected to
the thoracic drainage tube placed in the pleural
cavity
 Opening of one-way decompression valve
(vent) through which the system is
depressurized  don’t forget to remove it

Note: You have to place this bottle below the chest

 How does it works?
Pleural pressure + (abnormal)  the pressure in the
rigid straw becomes positive  if the positive pressure in
the rigid straw is > the depth to the tube that immersed
in the saline solution  then air will enter in the bottle
and then depressurized by vent into the atmosphere.
Pleural pressure (-) / normal  it will move liquid from
Rigid
straw the bottle to the rigid straw and air will not enter the
pleural cavity or the rigid straw

This system is called water seal because the water bottle

seals the pleural cavity from the air or liquid from the
outside of the body.

Note: You have to place this bottle below the chest

 How does it works?
If the liquid level rise/depth increase
 need greater pressure on the rigid
straw to remove additional air from
pleural cavity to the bottle  harder
Rigid
straw for the air to push through a higher
level of water  air staying in chest

Note: You have to place this bottle below the chest

 Next to…. two bottle system

Consist:
• First bottle (closer to the patient) 
collects the drainage
• Second bottle  the water seal,
which remains at 2 cm (water seal
and air vent)

Note: You have to place this bottle below the chest

 Last…. three-bottle system what we use now

Consist:
 Collection chamber  any drainage from the chest flows into this chamber, allow for easy measurement and
recording of the time, date, and amount of drainage
 Water seal  allow air to exit from the pleural space on exhalation and prevent air from entering the pleural
cavity or mediastinum on inhalation. It filled with sterile fluid up to the 2 cm line, a 2 cm water seal is established
 Suction control bottle  controlled application of suction

Note: You have to place this bottle below the chest

What we have now?

Water seal drainage, with the same principle as chest tube drainage system
 Wet vs Dry
regulate the To set the
amount of suction setting,
suction by the the dial is
height of a rotated at the
column of water prescribed
in the suction suction level.
control Suction can be
chamber set at −10, −15,
−20, −30, or −40
cm of water.

Usually, it is set in -20

4 Things to Evaluate
Undulation
• Undulation
• Bubbles in Suction chamber
• Amount of fluid
Bubble
• Color of fluid
Fluid
 Undulation

Bubble

Fluid
Undulation
Bubbling in Suction
Chamber
Bubbling in water-seal chamber
(abnormal/not?)
Thank You…………………
Sources
• Zisis, C., Tsirgogianni, K., Lazaridis, G., Lampaki, S., Baka, S., Mpoukovinas, I.,
Karavasilis, V., Kioumis, I., Pitsiou, G., Katsikogiannis, N., Tsakiridis, K., Rapti, A.,
Trakada, G., Karapantzos, I., Karapantzou, C., Zissimopoulos, A., Zarogoulidis, K.,
& Zarogoulidis, P. (2015). Chest drainage systems in use. Annals of translational
medicine, 3(3), 43. https://doi.org/10.3978/j.issn.2305-5839.2015.02.09
• Porcel J. M. (2018). Chest Tube Drainage of the Pleural Space: A Concise Review
for Pulmonologists. Tuberculosis and respiratory diseases, 81(2), 106–115.
https://doi.org/10.4046/trd.2017.0107
• https://youtu.be/fY4FA2fxStY
• https://youtu.be/_OlzXZck3iw
• https://youtu.be/4bcp8GgzKGI
• https://endo.id/id/catalog/product/romo-seal