chest tubes

They are supposed to bubble.

My suggestion if you are uncertain about any specific equipment's workings, contact the manufacturer. They have reps who will give an inservice if needed, but who are also available to answer questions by phone or e-mail.

Ok, im glad that this is somewhat confusing to someone else. We use an Atrium waterseal system as well. I have the booklet put out by Atrium that explains how to manage the system. Lots of nurses on my floor think it is awful that it is not bubbling. From what I can read it could mean that the pnemo/hemo thorax has resolved. I have heard so many people say CT is bubbling....ie: must be ok...?????

Originally posted by jackieliz

Hi everyone,

Recently on the surgical unit I work one of the surgeons gave a short inservice on chest tubes. It stemmed from an incident he had with a nurse whom he thought was managing one incorrectly. He told us that if there is bubbling in the waterseal chamber it is ok because the patient has an airleak in the chest-the reason for the chest tube in the first place. I had thought that if the waterseal chamber bubbled it was due to an air leak in the tube or the collection system (we use atrium), and that we needed to assess where the leak is coming from, stop it if possible or call MD. We only get the occasional chest tube on the unit any way so I don't know what to think. The nurses I work with feel the same way I do. Advice???

The way the Doc explained is accurate. The system is supposed to bubble while there is an air leak ie maintaining pressure. When the bubbling quits in theory the air leak is resolved and thus the tube may be pulled. This is how they were intended to work but I see them pulled all the time while there is still bubbling, of course there will always be some leakage around the tube site is the theory for this.

We were taught that there should only be occasional bubbling in the water seal, constant bubbling indicates a leak. If wet suction is used, then you should see constant gentle bubbling in the suction chamber.

http://www.nursingceu.com/NCEU/courses/chestdrainagekm/

Just my 2 cents ....

There are few things we need to know about chest tube collection bottles. They have chambers and each chambers have functions....

1. There is the suction chamber. This chamber should be bubbling all the time when patienit is connected to suction. If on water seal, this does not bubble.

2. Collection chamber. This is where you have you blood collects. We do our O's from this chamber.

3. the famous water-seal chamber. Meaning it is "sealed." Manufacturer's have a specification on how many cc the fluid level is to provide a "SEAL". Should this bubble? If this bubbles, is it bad?

Well, it all depends. If the chest tube was placed to drain blood, liquids ( ex. hemothorax and post cardiothoracic surgical patients)

IT SHOULD NOT BUBBLE. If it bubbles then you have a leak. Is a leak bad? YES.

Now, if the chest tube is used for pnemothorax then the chamber should be bubbling. Should we be concern? NOT AT ALL. It was placed because of pneumo. When bubbling stops therefore pneumo is resolved. Also, in some instances when tubes are pleural chest tubes, there is sometimes small bubbling. Should we be worried. Not really.

I always orient nurses and teach them to always look at the water seal chamber. Always see if you have enough water based on the manufacturer's specification to creat a SEAL. How you do this? Look at the water seal chamber at eye level. If the water is not leveled with the line as provided by the manufacturer then you add water to create the right seal.

2nd. Make sure connections are tight. Most specially the tubes and the rubber connection.

3rd. Asses the dressing and the sites.

4th. Look at the X-rays. One way to find out if your chest tube was dislocated/moved and pulled is to compare the new to the old x-ray. Locate for the holes at the side of the chest tubes( u can easily see this in the x-ray.). These holes should be inside the body of the patients. If its outside then you are in trouble. Obtain and vaseline gauze, applied pressure dressing and call the MD quick. This tube should be removed!