Basics of Chest Tubes

Introduction

• Purpose: Simplifying chest tube basics for patient assessment during rounds or pre-rounds.
• Focus: Clinical competency rather than test preparation.
• Objective: Improving chest tube management decision-making.

Anatomy of a Chest Tube

• Pleural Space: Normally only contains a vacuum with a small amount of pleural fluid.
• Purpose of Chest Tube: Inserted due to presence of air/fluid in the pleural space.

Components of a Chest Tube System

1. Water Seal: Prevents air from re-entering pleural space.
2. Collection Chamber: Gathers drained fluids without increasing resistance.
3. Suction Management: Maintains consistent suction pressure to avoid patient damage.

Types of Chest Tube Systems

• Atrium/Pleurabac: Commonly used systems with similar components.

Assessing and Managing Chest Tubes

Fluid Assessment

• Collection Chamber: Check fluid quantity and quality (e.g., pleural fluid, blood, pus).
• Daily Monitoring: Track fluid drainage and characteristics to inform management decisions.

Air Leak Assessment

• Normal: No air leak present.
• Types of Air Leaks:
  1. Valsalva: Bubbling during forced expiration (e.g., blowing on thumb).
  2. Expiratory: Air leak during exhalation.
  3. Inspiratory/Expiratory: Continuous air leak during both phases of breathing.
  4. Roiling: Severe continuous bubbles, may indicate major bronchial injury.

Criteria for Chest Tube Removal

• Air Leak: No or minimal air leak.
• Fluid Output: Normal fluid drainage with low volume output (usually <200 ccs/day).
• Types of Fluid: Drainage should be pleural fluid, not blood, pus, or other non-pleural fluids.

Decision-Making Tips

• Clinical Status: Patient's overall condition and respiratory status.
• Daily Chest X-Ray: Monitor for decreasing pneumothorax or fluid collections.
• Air Leak Documentation: Track changes in air leak status.
• Fluid Amount and Character: Assess daily fluid drainage for changes.

Management Plan Options

• For Improvement:
  1. Turn off suction (water seal).
  2. Consider pulling chest tube if conditions are met.
• For Deterioration: Increase suction (up to negative 40) or place additional chest tube if necessary.
• Caution with Clamping: Check institutional protocols before suggesting.

Conclusion

Objective: Equip with tools for efficient rounding and chest tube management decisions.

• Next Steps: Additional content on placing/pulling chest tubes or daily chest X-ray review upon demand.
• Disclaimer: Educational purposes only; not for diagnosing/treating diseases.

Best of luck with clinical rotations!