Today we’re going to talk about what to do when it seems like the chest tube is not functioning properly. (Everything here applies to any type of chest tube placed, not just large bore).
The biggest thing to take away from this is how to manage an air leak and only clamp the tubing when necessary and for a few seconds (not routinely and not for extended periods otherwise it can cause a tension pneumothorax).
Let’s start by talking about how you can tell the chest tube is functioning properly (aside from drainage and confirmed CXR).
You should see tidaling occur (as seen in graphic below) which demonstrates the water in the chamber moving according to a patient’s respirations.
There are multiple things that can indicate the chest tube is not working appropriately so let’s talk about what you would see and how to approach some of them.
There may be an air leak which you can find by looking for constant or intermittent bubbling in the water-seal chamber. (it is common to have some bubbling upon initial placement of the chest tube but watch for constant and a large amount of bubbling).
To find the source of the air leak, clamp the chest tube (only for a few seconds) starting from where it enters the chest and moving toward the pleur-evac. If the bubbling stops when you clamp the chest tube where it enters the chest, the problem is more likely internal and the chest tube might need to be completely replaced.
If the bubbling stops when any site more distal, along the tubing, is clamped, the tubing might need to be replaced.
If the bubbling stops close to where the tube enters the pleur-evac, the chamber itself might need to be replaced.
Subcutaneous emphysema at the site of the chest tube dressing could indicate a worsening air leak within the chest cavity and potentially even development of a tension pneumothorax so immediately obtain an x-ray to assess progression.
Drainage may stop → check for any kinks in the tubing and reposition the patient so they are upright. Always make sure the pleur-evac is below the level of the patient to allow proper drainage.
If the tubing accidentally gets disconnected, clamp the chest tube at the site closest to the dressing only briefly until the tubing can be replaced OR place the distal end of the chest tube in a bottle of sterile water so everything can continue draining until the equipment is replaced.
The list of things that can go wrong with a chest tube is never-ending but I wanted to mention some of the more common ones we may see while the patient is still in our ER.
Here’s another video to help with visualization (more helpful around 10:40 mark): https://www.youtube.com/watch?v=YOpzcWc3yrw&t=1139s
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https://opentextbc.ca/clinicalskills/chapter/10-7-chest-drainage-systems/
https://www.perplexity.ai/search/when-is-it-191OyTWbRqSV3.KHzmoORg#0