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