Chest tubes: air leak or no air leak?

[ahicks]

I am new to the ICU and I was wondering if anyone could give me some clarification about chest tubes. The way I understand it, if the chest tube is in place to drain fluid (such as after a CABG) you DO NOT want to see an air leak. However, if the chest tube is in place for a pneumothorax, you DO want to see an air leak because this represents air leaving the pts. chest cavity. Is this right?

[OptimusPrime]

Well, kinda and kinda not.

A chest tube is placed to drain either fluid and/or air. Even after CABG's, you will see an air leak sometimes, and that is fine. You just need to be aware of it and make sure it doesn't get worse. It means that there is air in the cavity and the chest tube is doing it's job, by draining the air. Just make sure everything is hooked up correctly.

If placing for a pneumothorax, ya, you want to see the air leak. If it's not there, then somethings wrong. Either your tubing is kinked, not hooked up to suction, no water in the suction port, chest tube placed incorrectly, mis-diagnosed pneumo, are some of the possibilities.

Eventually, the air leaks should disappear as the pneumo resolves.

[TakeBack]

To clarify-

"Air leak" means there is a patent channel which is either

1. inside the chest- injury to the lung, ruptured bulla, s/p lung resection. Air is entering the pt's trachea, traveling into the lung, across the injured lung/airway segment, and into the chest drain system (pleurovac, atrium) which you see as bubbles going through the water seal. This persistent leak means the lung/airway is not sealed. The CT should remain on suction until the leak (bubbling through the water seal) stops/

2. outside the chest- bad connections in the CT tubing, pleurovac can allow room air to enter the tubing/system and produce the same bubbling in the water seal. A quick way to check this is to clamp the tube right at the site where it enters the pt and see if the bubbling stops. If it doesn't, you have a leak distally in the system. With ongoing air leak, only clamp the tube transiently b/c intrathoracic air leak can accumulate as PTX, tension, etc.

Another site where air leaks can occur is right at the skin insertion site. Some hospitals use blake drains, and if the blake channels are exposed at the skin it will allow air to enter the tubing.

A CT placed for PTX will not always continue to leak air unless the cause of the PTX is a lung injury (ruptured bulla etc) instead of other causes (rib fx, post CTS etc).

[sethmctenn]

http://journals.lww.com/nursingmadeincrediblyeasy/toc/2010/01000

Check out the article "Get a positive outcome with negative pressure" It's a very clear primer on chest tubes