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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
Mesothelioma is a rare form of cancer that
develops from the protective lining that
covers many of the body's internal organs
Its most common site is the pleura

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

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

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

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