Collection chamber
Holds drainage. Mark the level and time each shift (or as ordered).
Report >100 mL/hour (or per order) or bright red drainage.
Water seal
One-way valve (~2 cm water). Tidaling (rise and fall with breathing) is normal.
Continuous bubbling = air leak. Intermittent bubbling on exhale/cough can be expected with a pneumothorax.
Suction control
Wet: gentle continuous bubbling (vigorous bubbling only evaporates water). Dry: dial set (often −20 cmH₂O) with the indicator showing.
Do
- Keep the unit upright and below chest level.
- Keep tubing free of kinks and dependent loops.
- Check dressing, insertion site, crepitus (subcutaneous air), breath sounds, SpO₂.
- Keep at bedside: sterile water and an occlusive dressing (and clamps if policy).
- Encourage coughing, deep breathing, incentive spirometry, pain control.
Don't
- Don't clamp routinely (risk of tension pneumothorax): only briefly to find a leak, to change the unit, or if ordered.
- Don't strip or milk the tubing routinely.
- Don't lift the unit above the chest.
Tidaling stopped?
Either the lung has re-expanded (good: confirm with X-ray), or the tube is kinked, clotted or blocked (check).
Emergencies
| Problem | Action |
|---|---|
| Tubing disconnected from the unit | Put the tube end 2–4 cm under sterile water, then reconnect or replace the unit. |
| Tube pulled out of the chest | Cover the site with a sterile occlusive dressing (taped on 3 sides if there's an air leak, per policy); stay with the patient; notify; watch for tension pneumothorax. |
| Unit knocked over | Set it upright; check the water seal level; notify if drainage mixed between chambers. |
Pneumothorax types
- Spontaneous: tall thin young adults, smokers, lung disease.
- Open (sucking chest wound): cover with a vented or 3-sided occlusive dressing.
- Tension: air trapped with each breath → shift of the mediastinum. Tracheal deviation away from the affected side, absent breath sounds, JVD, hypotension, severe distress. Emergency: needle decompression, then chest tube.
- Hemothorax: blood in the pleural space.
Memory hook
Air rises, fluid falls. A tube for air sits higher (apex); a tube for fluid sits lower (base). Many tubes for both are placed at the 4th–5th intercostal space, mid-axillary line.
Removal: patient holds breath or performs Valsalva as instructed; occlusive dressing; chest X-ray after.
Removal: patient holds breath or performs Valsalva as instructed; occlusive dressing; chest X-ray after.