1. Concepts on Oxygenation Chest tubes & Water seal Drainage

2. 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

3. Indications for Chest tube Drainage  Respiratory distress or ventilator dependence that does not permit thoracentesis  Monitor ongoing air leak or blood loss

4. 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 pleuracancerpleura

5. 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.

6. Types & Purposes of Chest Tubes cont’d. 2. Mediastinal tubes > are placed to en - sure that fluid does not accumulate & put pressure on the heart but instead drains to facilitate healing

7. 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

8. Principles of Chest Drainage

9. Principles Involved  Gravity  positive pressure  Suction  Water – seal principle

10. TYPES OF CHEST TUBE DRAINAGE SYSTEM

12. 1.SINGLE – BOTTLE WATER SEAL SYSTEM  The end of the drainage tube from the patient’s 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

13. 3. THREE- BOTTLE WATER SEAL SYSTEM  There’s an addition of a 3 rd 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