Education about chest tubes

[TxNurse287]

So Im a clinical educator, I'm working on education about chest tubes. I know that -20cmH2O is the most common order for dry suction control and less is for smaller people or pediatrics. Are higher negative pressures for larger people or is there other physiologic reasons to use for example -40cmH2O?

[Rose_Queen, BSN, MSN, RN]

I think you'll find a variety of preferences. For example, the surgeons I worked with always followed their rule of -20 for fluid and -10 for tissue. So if we were draining fluid, we'd set for -20. If we had done a lung resection, we'd set for -10. 

[MaxAttack, BSN, RN]

I'm curious about this myself. I knew -20 was the default but never knew the rationale for changing it.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4356865

Quote

 Patient situations that may require higher suction pressures of −30 or −40 cm H2O include: a large air leak from the lung surface, empyema or viscous pleural effusion, a reduction in pulmonary compliance, or anticipated difficulty in expansion of the pulmonary tissue to fill the hemithorax.

Thanks for the question because I learned something new.