Chest Tube Drainage

This will be a review of brief anatomy, reasons to place a chest tube, the components of chest tube drainage systems, and when to remove the chest tube.

Chest tubes are placed percutaneously at the bedside into the space between the lung (pleural lining) and the chest wall (parietal lining) with the purpose of draining air or fluid and occasionally can be used as a delivery method for medications.

A few reasons why patients may need a chest tube include a pneumothorax, hemothorax, empyema, and pleural effusions. A drain can sometimes be placed in the pericardial sac (covering surrounding the heart) to evacuate a pericardial effusion.

The drainage system usually comes as one box with multiple components. The best way to visualize this is the 3 bottle system. The first bottle represents the Collection Chamber. This is where you can see fluid accumulate as it is drained from the pleural space.

The second bottle is the Water-Seal Chamber. The level of water creates a one-way valve that allows air to exit the pleural space but not back into the pleural space. This chamber is where you look for “tidal” - water falls and rise with inspiration and expiration, demonstrating a patent chest tube. Continuous bubbling in this chamber is indicative of an “air leak” or air draining from a pneumothorax.

The third bottle represents the suction chamber. A drainage system can be attached to wall suction which usually creates a pressure of -20 cmH2O.

When deciding if it is time to remove a chest tube, usually you would observe improvement in your patient’s respiratory status. Then, you can take the chest tube off of suction and do a “water seal trial”. If there is a lack of an air leak over 8 hours, you can obtain a chest x-ray and see if the pneumothorax has resolved. If so, this would be the time to remove the chest tube.