Chest tube to suction?

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If a patient has an order for a chest tube to 20cm wall suction does it make a difference if it's connected directly to the suction regulator or if it's connected to a canister (such as a canister for NGT drainage)? Will the suction be the same?

Specializes in cardiac/critical care/ informatics.
We just hook the chest tube suction line directly to the wall suction. The pleurevac serves as the canister. You set the "20cm" of suction by the pleurevac regulator.

yea this is how we do it as well.

but the suction -20cm is regulated on the plueravac or atrium what ever kind you use.

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Specializes in Peds.
yea this is how we do it as well.

but the suction -20cm is regulated on the plueravac or atrium what ever kind you use.

Same for us. We might have multiple chest tubes and some of our suction regulators are y-connectors so we can have two pleurevacs with only one vacuum outlet.

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

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Specializes in ICU.

The risk of the chest tube being off of suction is that what ever is causing the pneumo won't get sucked out. If it's an empyema, blood or something else, it needs to come out, and the suction helps that.

As far as your second question, I don't know if you misspoke or if you are confused. The chest tube should never be open to air. This is how air gets sucked into the pleural space causing a tensions pneumo. The chest tube can be off suction however. The MD may write to put the suction to water seal. This means it is hooked to a closed system but not hooked to suction. The water seal allows the lung to re-expand, air to escape, but no air to come in.

Remember, if you see bubbling in the chamber, you have a leak and the tube is open to air somewhere. Clamp it immediately and find the source of the leak and fix it.

I hope this helps.

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I meant if the patient has a chest tube connected to Pleur evac and wall suction and the CXR showed no pneumothorax. The doctor writes and order saying to turn suction off. Do you just turn suction off and leave suction tubing connected to suction source/wall (isn't this the same concept of clamping?) or do you need to disconnect it from the suction source/wall so that air cannot build up (chest tube still connected to Pleur evac)?

I had this order at shift change and i asked the oncoming RN what we should do and they didn't know either (don't have many chest tubes on our floor). Didn't work the next day so not sure what the answer was.

Also, I've found articles saying never to clamp chest tubes, but is this only if the pneumo is not resolved? Because I've also read that clamping is sometimes done for a few hours before taking out the chest tube to ensure that the pneumo will not come back once the chest tube is out???? I know that a tension pneumothorax is a risk, but only if air is still leaking into the pleural cavity?

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Specializes in ICU.

I meant if the patient has a chest tube connected to Pleur evac and wall suction and the CXR showed no pneumothorax. The doctor writes and order saying to turn suction off. Do you just turn suction off and leave suction tubing connected to suction source/wall (isn't this the same concept of clamping?) or do you need to disconnect it from the suction source/wall so that air cannot build up (chest tube still connected to Pleur evac)?

OK-I think I'm following you a little better now. The order says turn the suction off, then you can d/c the suction from the wall, but keep the chest tube connected to the pleur evac. This is different from clamping because air can still escape into the water.

Also, I've found articles saying never to clamp chest tubes, but is this only if the pneumo is not resolved? Because I've also read that clamping is sometimes done for a few hours before taking out the chest tube to ensure that the pneumo will not come back once the chest tube is out???? I know that a tension pneumothorax is a risk, but only if air is still leaking into the pleural cavity?

That is correct. You don't clamp a chest tube if the pneumo is not resolved, otherwise the air won't get out. Only clamp if you find an air leak (bubbling in the water chamber). The doc will may test clamp the tube if he thinks the pneumo resolved and wants to make sure. Other docs just leave it in until they are 100% sure that the lung fully re-expanded (good CXR/no fluctuations with resps etc.) and then pull it. I guess it's personal preference.

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