A chest tube is a flexible, hollow medical device inserted through the chest wall. Its purpose is to remove air, fluid, or blood from the space around the lungs (pleural space) or other chest areas. Conditions requiring a chest tube include a collapsed lung (pneumothorax), fluid accumulation around the lungs (pleural effusion), or blood in the chest cavity (hemothorax), often from trauma, surgery, or infection. The tube helps re-establish normal chest pressure, allowing the lungs to expand fully.
Understanding Chest Tube Drainage
After a chest tube is placed, the drainage collected is observed for appearance, consistency, and volume. Initially, especially after surgery or trauma, drainage may appear bloody (sanguineous). As the patient recovers, the color should lighten, transitioning to pinkish or reddish-brown (serosanguinous), then clear or straw-colored (serous).
The amount of fluid collected should decrease over days as the condition improves. Drainage collects in a specialized, airtight system with multiple chambers, allowing fluid measurement and air escape without re-entry. While there isn’t a single universal “normal” daily output, the trend should show a steady reduction in volume.
Recognizing Excessive Drainage
Monitoring chest tube drainage involves careful attention to both the amount and its characteristics, as certain changes can indicate a problem. An initial output of over 1500 milliliters of blood immediately after chest tube insertion for a hemothorax is concerning. A sustained high rate of drainage, over 100 to 200 milliliters per hour for two to four consecutive hours, warrants prompt medical evaluation. If more than 100 milliliters of blood drains in one to two hours post-procedure, it is considered significant.
Sudden changes in the fluid’s appearance also indicate a problem. Drainage that becomes bright red and free-flowing, or a sudden increase in blood clots, can suggest ongoing bleeding. Excessive drainage is concerning as it can lead to significant blood or fluid loss, potentially resulting in a drop in blood pressure or other complications. Rapid removal of large fluid volumes, especially over 1.0 to 1.5 liters per hour, can increase the risk of fluid buildup in the lungs.
Other Signs of Complications
Beyond the amount of drainage, other physical signs can indicate potential problems with a chest tube. Patients might experience increased shortness of breath or new or worsening chest pain. The presence of a fever or signs of infection around the insertion site, such as redness, swelling, or pus, requires attention.
Mechanical issues with the tube can lead to complications. This includes the tube becoming dislodged, kinked, or blocked, which can hinder proper drainage. An unexpected continuous bubbling in the water seal chamber, not associated with coughing or exhaling, can signal an air leak from the lung or a system problem. Changes in vital signs (rapid heart rate or low blood pressure) and a crackling sensation under the skin (subcutaneous emphysema) indicate medical attention may be needed.
When to Seek Medical Attention
It is important to contact the healthcare team immediately if any concerning changes are observed in chest tube drainage or the patient’s condition. These include excessive drainage amounts, significant changes in drainage color, or any other signs of complications discussed. Prompt reporting allows medical professionals to assess the situation and intervene if necessary. Patients should not attempt to adjust or remove the chest tube themselves. Consistent monitoring and communicating any new or worsening symptoms to the healthcare provider are important for patient safety and effective management.