Questions and answers

Where do you put chest drain for pneumothorax?

Where do you put chest drain for pneumothorax?

The drain should be inserted just above the rib. Any other placement should be discussed with a senior clinician eg. in the presence of an apical pneumothorax, placement of a chest tube in the 2nd intercostal space should be considered. A specific position may also be required for a loculated effusion.

How does a water seal chest drain work?

Single chamber underwater seal chest drain The patient’s chest tube is submerged under a level of water (usually about 2cm) which acts as a one-way valve. When the patient takes a breath in, the negative intrapleural pressure will suck drain water up the tube, but no additional air can enter.

What are the complications of underwater seal drainage?

Pleural drain complications

  • Tension pneumonthorax.
  • Trauma to intrathoracic structures, intra-abdominal structures and intercostal muscles.
  • Re-expansion pulmonary oedema.
  • Haemorrhage.
  • Incorrect tube position.
  • Blocked tube.
  • Pleural drain falls out.
  • Subcutaneous emphysema.

What are the indications for underwater seal drainage?


  • Pneumothorax (spontaneous, tension, iatrogenic, traumatic)
  • Pleural collection – Pus ( empyema), blood ( hemothorax), chyle ( chylothorax)
  • Malignant effusions (pleurodesis)
  • Postoperative.
  • Thoracotomy.
  • Video-assisted thoracoscopic surgery (VATS)

When do you drain a traumatic pneumothorax?

In general, a chest drain is indicated if a haemothorax is sufficiently large to be seen on chest x-ray. Avoid tension of existing pneumothorax, given planned intermittent positive pressure ventilation (IPPV) for lower leg fracture.

How much chest tube drainage is too much?

Compared to a daily volume drainage of 150 ml, removal of chest tube when there is 200 ml/day is safe and will even result in a shorter hospital stay.

Is continuous bubbling normal in chest tube?

Air bubbling through the water seal chamber intermittently is normal when the patient coughs or exhales, but if there is continuous air bubbling in the chamber, it can indicate a leak that should be evaluated.

What to do if there is an air leak in a chest tube?

If bubbling disappears when you clamp the tubing, suspect an air leak at the insertion site or from within the chest wall. Assess the insertion site; if you detect a leak, apply petroleum gauze and a sterile occlusive dressing to seal it off.

What are the types of underwater seal drainage?

Three types of underwater seal drainage systems are available: the 1-bottle, the 2-bottle, and the 3-bottle system. o In the 1-bottle system the chest drain is connected by collecting tubing to a tube approximately 3 cm under water (the seal) in the underwater-seal bottle while another vent tube is open to atmosphere.

When should I clamp my chest drain?

The practice of clamping the chest drain before removal in spontaneous pneumothorax appear safe. Clamping saved chest drain reinsertion in 11.8% of cases, and has the potential to save more if clamped for up to 24 h. However, clamping may result in more early recurrences. Prospective randomised studies are needed.

What does continuous bubbling in chest tube mean?

Air Leak (bubbling) Continuous bubbling of this chamber indicates large air leak between the drain and the patient. Check drain for disconnection, dislodgement and loose connection, and assess patient condition.

What causes air leak in chest tube?

If an air leak lasts > 5 to 7 days, it is termed a persistent air leak (PAL). A PAL is commonly caused by a spontaneous pneumothorax from underlying lung disease (secondary spontaneous pneumothorax), pulmonary infections, complications of mechanical ventilation, following chest trauma or after pulmonary surgery.

What does water seal mean for chest drainage?

Water seal chest drainage means that a column of water in a bottle seals off the atmospheric air preventing from entering the chest drainage tube and thereby in the pleural sac

How is a chest tube used to treat pneumothorax?

The placement of a chest tube connected to a water-sealed drainage system is the next step in treating the pneumothorax. The air leak may be repaired by the normal processes of the lung as the free air is being removed through a chest tube; if not, then surgical repair is needed to stop the problem.

Can a patient with pneumothorax breathe with a dry drain?

Q. Can you please advise whether continuous bubbling should be present in the air leak chamber whilst on continuous wall suction in a patient with a spontaneous pneumothorax who is breathing spontaneously with a dry suction drain? By the way – if the patient was ventilated, what would the difference be?

Which is the middle chamber of a chest drainage system?

The middle chamber of a traditional chest drainage system is the water seal. The main purpose of the water seal is to allow air to exit from the pleural space on exhalation and prevent air from entering the pleural cavity or mediastinum on inhalation.