Chest tubes are hollow plastic tubes inserted into the chest cavity to drain fluid, blood, or air. They use suction to drain into a collection chamber and are removed when drainage becomes minimal. The Atrium Oasis chest drain system used at WCMC provides dry suction drainage and has indicators to monitor suction and detect air leaks."

1. Chest Tubes
 A chest tube is a hollow plastic tube that is
inserted into the chest cavity to remove or allow
the drainage of fluid, blood, or air from that
portion of the chest cavity
 They are removed when drainage becomes
minimal
 Drainage is marked on the collection chamber
and documented every 8 hours

2. Chest tubes (continued)
 WCMC uses the Atrium Oasis chest drain
 The Atrium Oasis chest drain is a disposable, dry suction
operating system with 2100 ml collection volume, dry suction
regulator, and calibrated water seal
 Dry suction chest drains require higher levels of vacuum
pressure and air flow from the suction source
 For gravity drainage, disconnect the suction line and maintain
drain below patient’s chest

3. Chest Tubes (continued)
 Highly visible suction
monitor bellows (E) readily
confirms suctions operation
 Large, easy-to-read
collection chamber (D)
numbers and graduations
 Chest drains include
sampling port in patient tube
(not pictured)

4. Chest tubes (continued)
 Ensure that the dressing is intact during assessment
 Medicate patients for pain as indicated - chest tubes are always
uncomfortable and often painful
 Gentle rise and fall with inspiration and expiration within the
water seal chamber (tidaling) is normal
 If bubbles are noted in the water seal chamber, check for an air
leak
 Keep chest tube clamp & occlusive dressing at bedside
 Keep a straight path between the tubing and the patient to
facilitate drainage
 Keep container for drainage below level of the patient’s chest in
an upright position at all times

5. Chest tubes (continued)
Chest tube initiation
 Gather supplies (sterile gloves, suction equipment, chest
tube, several towels and chest tube insertion tray) as ordered,
place at bedside
 Educate patient on procedure; have permit signed
 Twist top off provided sterile water
 Insert tip into suction port
 Squeeze contents into water seal until fluid reaches 2cm fill
line - water will tint blue for visibility
 Position patient as instructed and assist physician in the
insertion of the chest tube
 Connect drain to patient prior to initiating suction

6. Chest tubes (continued)
Chest tube initiation (continued)
• Attach suction line to suction port on top of drain
• Turn suction source on
• Increase suction source vacuum to -80 mmHg or higher
• Suction regulator is preset to -20 cmH2O
o Adjust as ordered
 To avoid accidental turning over of the Atrium, place the unit on
the floor or hang it at the bedside with the hangers provided
 Use needless luer port on patient tube connector for sampling
when needed

7. Chest tubes (continued)
 Suction bellows will expand to the mark or beyond when
suction is connected and operating at a regulator setting of -
20 cmH20 or higher
 If the bellows is expanded but less than the mark, increase
the vacuum to -80 mmHg or higher
 For regulator settings less than -20 cmH20, any visible bellows
expansion in bellows window will confirm suction operation
 Suction regulator is preset to -20 cmH20
 To change setting, adjust rotary suction regulator dial

8. Chest tubes (continued)
 The water seal must be filled to the 2 cm fill line for system
operation and air leak detection
 Once filled, water seal becomes tinted blue
 When air bubbles are observed going from right to left, this
will confirm an air leak
• Continuous bubbling confirms a persistent leak
• Intermittent bubbling confirms an intermittent leak
• No bubbling with minimal float ball oscillation will indicate
no leak is present
 The air leak detector is gradual and ranges from 1 (low) to 5
(high)

9. Chest tubes (continued)
Chest tubes are never emptied
 When the collection chamber is full or damaged, the entire drain
is changed
• Open the new chest tube drainage container
• Fill water seal chamber to line with provided water
• Set suction control regulator
• Clamp the line with the attached clamp
• Remove line from old drainage container
• Insert line to new drainage container
 Check tube connections, water seal, suction regulator, and
bellows often to confirm proper operation

10. Chest tubes (continued)
Chest tube removal
• Gather supplies (towels, suture removal tray, occlusive
dressing, gloves)
• Pre-medicate patient for pain and educate on procedure
• Remove dressing and discard, noting drainage
• Assist physician with procedure
• Discard chest tube container and all tubing in a biohazard
waste container
• Document procedure and output