Hello! Today I had a day 3 post CABGs who has had a persistant bubble/ air leak from his MSDT's (chest tubes) and hence the doctors wanted to leave the offending chest tube in. I understand that when assessing for a swing/ bubble I need to stop suction, but this patients bubble was absent when suction was off, and present when suction was on. The nurse who I handed over to said that this is not classified a a bubble, as it was not occuring while he was off suction. My argument was that regardless, a mediastinal chest tube should not be bubbling at all.

What are your thoughts, guys? Would you call this an air leak?

Cheers.

Hello! Today I had a day 3 post CABGs who has had a persistant bubble/ air leak from his MSDT's (chest tubes) and hence the doctors wanted to leave the offending chest tube in. I understand that when assessing for a swing/ bubble I need to stop suction, but this patients bubble was absent when suction was off, and present when suction was on. The nurse who I handed over to said that this is not classified a a bubble, as it was not occuring while he was off suction. My argument was that regardless, a mediastinal chest tube should not be bubbling at all.

What are your thoughts, guys? Would you call this an air leak?

Cheers.

It is an air leak. I would take the dressing down and ensure it is patent and leave the patient on wall suction. The latest information I've read said not to use vaseline impregnated gauze around the chest tube, and only to tape the dressing on three sides to prevent crepitus. There is also some debate on whether the air leak will resolve better with or without suction. Sometimes though this is doctor specific. Some do some don't. It's best to call.

I would suspect the tube has slipped out slightly and one of the holes is partially exposed or close to the skin and "sucking" air.

What is the risk of the suction being off and suction tubing/air valve not open to air?

Just to clarify can you indicate where the bubbling was occuring?

There are 3 chambers on collection sets:

1. Collection chamber (drain)

2. Water seal

3. Water suction chamber with the 20cm of water

If the bubbling occured in the water suction #3 the bubbling is normal. It should be continuous when the suction is on.

If the bubbling occurred in the water seal portion #2 then there is an air leak. Here's what you have to ask:

a. Does the leak occur with expiration or inpsiration? (ask the person to cough, if bubbling is present on INSPIRATION it will be very obvious when the person inhales deeply to cough, and the bubbling will be very obvious with the cough if it occurs with EXPIRATION.

b. If this occurs with Expiration then the person has probably a small pneumo

c. If this occurs with Inspiration AND Expiration, usually a bad sign, check your tubing for a failed connection or your chest tube insertion for a possibly dislodged tube.

Again, bubbling is normal on the 20cm of water suction with the SUCTION ON. An air leak by definition occurs in the small chamber (usually middle) and can occur with inspiration or/and expiration or continuous.

Hope that helps.