Chest tube (water seal chamber)

[miamiheatrn, BSN]

When dealing with pleuro-vac's is it true you wont have any intermittent bubbling in the water seal chamber when there is wall suction present? I understand gentle or intermittent bubbling in this chamber may be seen in the presence of pneumothorax. But was told today it will be absent if theres wall suction present. Is this true?

[Wuzzie]

Intermittent bubbling in the water seal chamber will be present if there is still an air-leak regardless of whether it’s on wall suction or not. It will be absent only if there is no longer an air-leak. Confusion was caused when the Pleur-Evac company developed a “dry suction control” chamber. They used to only have a “wet-suction control” chamber where the amount of suction was controlled by the level to which you filled the chamber with water. This was meant to have continuous bubbling. When facilities switched to the dry suction style with a dial some people got confused when they were told that there would be no more bubbling. Sadly this is because they don’t really have a complete understanding of how these systems work so they don’t actually know what the different chambers are for.

[miamiheatrn, BSN]

So some bubbling can be expected in the presence of pneumothorax with or without wall suction?

[Wuzzie]

9 hours ago, miamiheatrn said:

So some bubbling can be expected in the presence of pneumothorax with or without wall suction?

Yes. If a pulmonary air leak is still present you can expect to see intermittent bubbling in the water seal chamber that correlates with the patient’s expirations with or without suction. However, if there is continuous bubbling in the chamber and the device is hooked to suction you have a system leak and you need to check all of your connections. Who exactly is telling you differently?

[offlabel]

On 1/28/2019 at 10:07 PM, miamiheatrn said:

So some bubbling can be expected in the presence of pneumothorax with or without wall suction?

Well, wait a minute.

Technically speaking, the pneumothorax should be mostly resolved with the chest tube. The thing that caused the pneumothorax, the hole in the lung, may or may not still be there. An "air leak" is another way of saying "there is still a hole in the lung". If the hole seals off, a patient who got a chest tube for a pneumothorax will not have an air leak, suction on or not. But, yes, if there is a persistent hole in the lung, you'll see evidence of the leak (with bubbling) whether or not there is continuous suction applied to the system.

[offlabel]

On 1/28/2019 at 4:03 PM, Wuzzie said:

Intermittent bubbling in the water seal chamber will be present if there is still an air-leak regardless of whether it’s on wall suction or not. It will be absent only if there is no longer an air-leak. Confusion was caused when the Pleur-Evac company developed a “dry suction control” chamber. They used to only have a “wet-suction control” chamber where the amount of suction was controlled by the level to which you filled the chamber with water. This was meant to have continuous bubbling. When facilities switched to the dry suction style with a dial some people got confused when they were told that there would be no more bubbling. Sadly this is because they don’t really have a complete understanding of how these systems work so they don’t actually know what the different chambers are for.

The water seal chamber served two purposes. One was, of course, just to provide the "water seal" which was to prevent entrainment of air retrograde up into the pleural space, thus not helping or making a pneumothorax worse. The other was to provide an audible confirmation that there was indeed suction being applied to the lung, which would be critical to know in mechanically ventilated patients as the risk of a tension pneumo could be increased in the absence of wall suction. This has proven to be an issue as bedside RN's have had to adjust to the lack of noise in a properly functioning system. It's less of an issue with spontaneously breathing patients.