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Chest Drain

Last modified: 12 August 2022, 7:39:22 AM AEST

Gems1 / 6

normal drainage\n
- 200-400 mL/24 hours postop
- 100 mL/hr is dangerous
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Technique / description2 / 6

triangle of safety\n
- anterior to mid axillary line
- posterior to pectoral groove
- above 5th intercostal space
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Drainage systems3 / 6

1-bottle system

1 = underwater seal\n
- inspiration = UWS prevents entrainment of RA
- expiration = air bubbles and is removed
- water level = usually 2 cm for water seal
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advantages\n
- simple and cheap
- good for AIR only
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disadvantages\n
- unable to drain pleural fluid\n
  - fluid will keep collecting = fluid level rises
  - ⬆pressure require to breathe
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- pleural fluid will cause frothing\n
  - difficult to read fluid level
  - aesthetically unappealing
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- drained fluid can reflux back into thorax if chest drain elevated above level of chest
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2-bottle system

1 = Drainage bottle\n
- drains pleural FLUID
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2 = Underwater seal\n
- as per 1-bottle system
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Advantages\n
- No froth = pleural fluid and water seal are separate
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Disadvantages\n
- Less effective draining AIR\n
  - 1st chamber is essentially an extension of the pleural space
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3 bottle system

1 = Fluid collection bottle
2 = Underwater seal\n
- as long as this bottle is below patient, the hydrostatic pressure of the fluid column in bottle will counteract negative pleural pressure, and prevent water being sucked into pleural space
- volume must exceed 1/2 maximum inspiratory volume (prevent entrainment of air during inspiration)
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3 = Suction Pressure Regulator\n
- Pressure-regulating bottle = allows suction to be attached
- 1: input tube = above water
- 2: vent tube = open to RA, other end is UNDERWATER
- 3: output tube = above water = attached to suction
- suction applied through 20 cm of H2O = this limits the negative pressure applied to pleura
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Advantages\n
- allows adjustable suction to be attached = more efficient\n
  - change depth of manometer vent tube in 3rd bottle
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- Effective for both AIR and FLUID
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Disadvantages\n
- Continuous bubbling = either a feature or a bug
- No failsafe for suction failure\n
  - If suction is occluded, the air pressure in all chambers will increase = re-expansion PTX
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4-chamber system

4 = another (3rd) underwater seal\n
- attached to FIRST chamber, open to air via underwater seal
- prevents patient from PTX (from air building up in bottle 3) in the event of sudden suction failure (chamber 3)
- ie. it is the SAME as bottle 2
- called \"vent bottle\"
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Observations4 / 6

Air leak\n
- Bubbling in UWS
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Oscillation\n
- Respiratory swing
- Does not occur when suction is applied (unless major thoracic surgery with large intrathoracic volumes)
- No oscillation\n
  - Occlusion / blockage
  - Lung has re-expanded fully
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Common questions / related topics5 / 6

Clamping

Never clamp\n
- Tension PTX
- Still bubbling
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Excessive wet suction in 3rd bottle

Eg. Atrium Ocean Wet Suction Water Seal Chest Drain
Eg. -80 cmH2O
Maximises air leak\n
- To a degree
- lower levels for infants and patients with friable lung tissue
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⬆Airflow through system\n
- More noise and discomfort for patient ***
- Increased evaporation of liquid from control bottle ***\n
  - This results in lower amount of suction applied as level of water decreases
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After a certain amount, minimal effect on amount of suction imposed on chest cavity
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4356865/
https://www2.getinge.com/dam/hospital/documents/english/ocean_water_seal_handbook-en-non_us.pdf

Excessive dry suction

Eg. Atrium Oasis Dry Suction Water Seal Chest Drain
Wall suction is set to -80 cmH2O
Adjustment from -10 to -40 cmH2O
Preset to -20 cmH2O

References6 / 6

https://litfl.com/underwater-seal-chest-drainage-system/

https://derangedphysiology.com/main/required-reading/equipment-and-procedures/Chapter%20262/underwater-seal-chest-drain-system

https://litfl.com/intercostal-catheter-chest-drain/

https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Chest_drain_management/

https://www.derangedphysiology.com/files/CHEST%20DRAIN%20SYSTEMS.pdf

https://www2.getinge.com/us/education/chest-drain-education/#

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