Can you explain a chest tube leak?

augigi, CNS · Sep 25, 2006

Well, usually you're just draining air from the chest (pneumothorax). If you have a non-occlusive dressing, you could also be sucking air in which then passes out the tube.

jmgrn65, RN · Sep 25, 2006

A leak that is demonstrated in the pleura vac is not at the drs site. The leak is usually in the pleural space, if the pt has a pnemothorax or has had a thoracotomy it hasn't sealed up yet.

If there is a leak at the dressing you will hear the sucking sounds or air trying to escape there.

Dinith88 · Sep 26, 2006

When you've got bubbling going on in a Pluerevac, WHERE exactly might the leak be? Some people have said it's at the dressing site, but this doesn't make sense to me. The open end of the tube is in the pleural space, right? If the Pleurevac is emptying blood from the pleural space, and air is entering the system, where is it coming from???
Forever confused,
GermPhobe

An air-leak in the system could be coming from ANYWHERE proximal to the pleurevac...If the leak is new, a thorough(sp?) assessment of the tube, connections, pleurevac, and dressing/puncture site should should be done because if it's a break in the system, it's usually something you can fix.

IN simplest of terms, the chest-tube system is a vacuum ('suction cup') that exerts enough 'sucking force' to keep the lung expanded. If a 'hole' (leak) exists anywhere (from the source of the suction (plerevac box) to the lung) along this 'vaccum', air will be 'sucked' into the 'vaccum' from the breach ('hole')...and this is where/why/when the air-leak 'bubbles' occur...

Or...pretend you're sucking down a milk-shake (straw is the chest tube, shake is the lung/pleura, your mouth is the plerevac/wall suction)...if someone then pokes a hole anywhere in your straw you'll suck air (ie a leak in the tubing or connections)...or if your straw isnt quite into the shake you'll suck air (ie a leak from puncture and/or pleural space)...in either case you're sucking air into your mouth (if a water-seal chamber were in your mouth it would bubble)

Yes you can sometimes hear air being sucked in from the puncture/incision site if a big leak is occuring there...but whether you do or not, you'll STILL get bubbles in your water-seal. (btw, this is rare and 'usually' occurs when someone pulls/bumps/displaces a relatively new tube...and makes for a bad day for all involved)...

SO...an air-leak/bubbles in the water-seal chamber only tells you that there IS an air-leak...but not WHERE it is occuring...

and..you can have air-leaks whether the tube is there to drain effusion, to re-expand pneumothorax...or draining mediastinum post open-heart...or etc...it doenst matter...air leaks can occur.

GermPhobe · Sep 26, 2006

SO...an air-leak/bubbles in the water-seal chamber only tells you that there IS an air-leak...but not WHERE it is occuring...
and..you can have air-leaks whether the tube is there to drain effusion, to re-expand pneumothorax...or draining mediastinum post open-heart...or etc...it doenst matter...air leaks can occur.

Thank you, Dinith. I like the milkshake analogy. I guess I should have asked where the most likely place for an air leak would be. The cases I remember where docs were really upset about leaks were thoracotomies. In this case, the pleurevac would be draining blood from the pleural space, right? And a leak would probably be due to the "straw" not being dipped deep enough into the "milkshake," right? I guess what throws me is that I don't picture "free air" in the body. I was wondering where the pleurevace was drawing the air from.

Am I still way off base?

Dinith88 · Sep 28, 2006

Thank you, Dinith. I like the milkshake analogy. I guess I should have asked where the most likely place for an air leak would be. The cases I remember where docs were really upset about leaks were thoracotomies. In this case, the pleurevac would be draining blood from the pleural space, right? And a leak would probably be due to the "straw" not being dipped deep enough into the "milkshake," right? I guess what throws me is that I don't picture "free air" in the body. I was wondering where the pleurevace was drawing the air from.
Am I still way off base?

That whole milkeshake thing was probably a bit too simplified.. :)

Before you can understand air-leaks in thoracotomies, you have to think back to A&P...remember there are essentially two pleura...one that lines the lungs and another that lines your thoracic cage...they provide lubrication, help keep lungs expanded, etc....and normally there should be no blood, air, or etc. between them.

When a thoracotomy is done, it's typically done to remove a section of lung (tumor). NOw, with this in mind, it goes without saying that by surgically resecting a portion of lung, you'll have to remove and/or cut through a significant pleura. So...after the portion of lung/pleura is removed, the remaining lung/pleura has to be sewn/stapled and repaired. The pleura that lines the lung (visceral pleura?) will therefore (obviously) need to heal itself over time in order to 'seal' itself shut. The chest-tube that is inserted during surgery is there to keep the lung expanded post-op...and to drain any blood that may accumulate. THe end of the chest-tube will be within the pleural space (between the two pleura) and not directly in the lung. If the pluera that lines the lung isnt completely sealed (common immediately post-op), air will escape the lungs and get into the pleural space.(if chest-tube werent there, pt would develope pneumothorax). This is how/why the chest-tube will be 'sucking air' and causing bubbles in your chamber. Like a previous poster said, it may take a day or few for the pleural lining to seal itself...and therefore a few days for you to stop seeing an air-leak.

Sometimes, if a patient comes back post thoracotomy without an air-leak, but then developes one a day or so later, the surgeon may be a bit disappointed because his good seal may have opened a bit (but again should hopefully re-seal itself). You're absolutely corret that the air-leak isnt coming from some free-air in the sub-q tissues. The air is coming directly from a leaky-lung that hasnt yet sealed.

GermPhobe · Sep 28, 2006

Thank you again! I knew that the end of the tube was in the pleural space (and even the anatomy of the pleural space), but I just wasn't getting the fact that the visceral pleura was damaged--allowing leakage from the LUNGS into the tube. DUH! I feel so dense. Thank you for enlightening me. This has been bugging me for quite some time, and I've never gotten a satisfactory answer from any of the nurses on my floor.