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Chapter 10. Tubes and Devices
10.6 Chest Tube Drainage Systems
A chest tube, also known as a thoracic catheter, is a sterile tube with a number of drainage holes inserted into the pleural space (see Figure 10.8). The pleural space is the space between the parietal and visceral pleura, and is also known as the pleural cavity (see Figures 10.9). A patient may require a chest drainage system any time the negative pressure in the pleural cavity is disrupted and causes respiratory distress. Negative pressure is disrupted when air, or fluid and air, enters the pleural space and separates the visceral pleura from the parietal pleura, preventing the lung from fully expanding and collapsing. Small amounts of fluid or air accumulating in the pleural space are often absorbed by the body without a chest tube.
Figure 10.10 demonstrates a pneumothorax. A large amount of fluid or air cannot be absorbed by the body and will require a drainage system in order to optimize oxygenation (Bauman & Handley, 2011; Perry et al., 2018). Another type of chest tube called a Heimlich valve is discussed later in this chapter.
The location of the chest tube depends on what is being drained from the pleural cavity. If air is in the pleural space, the chest tube will be inserted above the second intercostal space at the mid-clavical line. If there is fluid in the pleural space, the chest tube is inserted at the fourth to fifth intercostal space, at the mid-axillary line. A chest tube may also be inserted to drain the pericardial sac after open heart surgery. These tubes are placed directly under the sternum and are referred to as mediastinal chest tubes (Perry et al., 2018).
Some conditions that may require a chest tube drainage system include (Bauman & Handley, 2011; Perry et al., 2018):
Pleural effusion
Pneumothorax
Hemothorax
Spontaneous pneumothorax
Tension pneumothorax
Traumatic pneumothorax (stab or gunshot wound)
Cardiac tamponade (accumulation of blood surrounding the heart after open heart surgery or chest surgery)
Chest Tube Drainage Systems
A chest tube is connected to a closed chest drainage system, which allows for air or fluid to be drained and prevents air or fluid from entering the pleural space. Because the pleural cavity normally has negative pressure, which allows for lung inflation and deflation, any tube connected to it must be sealed so that air or liquid cannot enter the space where the tube is inserted (Bauman & Handley, 2011; Rajan, 2013). In a chest drainage system, a water seal provides that protection. Chest tube drainage systems are sterile and disposable and consist of either two or three compartments (see Figure 10.11). The traditional chest drainage system typically has three chambers (Bauman & Handley, 2011; Rajan, 2013). Figure 10.12 illustrates how a chest drainage system works. Note how the three chambers are connected and the path that