Chest tubes are medical devices that help patients recover from conditions affecting the space around their lungs. This space, known as the pleural space, normally maintains a negative pressure that allows the lungs to expand and contract with breathing. When air or fluid accumulates in this area, it can compromise lung function, potentially leading to a collapsed lung. Chest tubes are inserted to remove these unwanted substances, re-establish normal pressure, and facilitate lung re-expansion. They are used after chest surgery or to treat conditions like pneumothorax (air in the pleural space) or hemothorax (blood in the pleural space).
How Chest Tubes Work
A chest tube connects to a drainage system, typically a sealed unit. This system removes air or fluid from the pleural space and prevents its re-entry. Drainage systems typically have three main chambers. The collection chamber gathers drainage from the patient, with calibrated markings to measure volume.
The water seal chamber contains sterile water, usually filled to a 2 cm mark. This chamber functions as a one-way valve, allowing air to exit the pleural cavity during exhalation but preventing outside air from re-entering. Some systems also include a suction control chamber, which regulates the negative pressure applied to assist drainage. The entire system must be kept below the patient’s chest level to facilitate gravity drainage and prevent backflow.
Understanding Bubbling Patterns
Bubbling patterns in the water seal chamber provide important insights into the chest tube’s function and patient condition. These patterns indicate air movement through the system.
Intermittent bubbling, which appears and disappears with the patient’s breathing, coughing, or sneezing, is a normal and expected finding. This indicates the chest tube is effectively removing air from the pleural space, such as residual air or air escaping as the lung re-expands. The bubbling may increase during exhalation or coughing due to increased chest pressure.
Another normal observation in the water seal chamber is “tidaling.” This refers to the fluctuation of the water level with respiration. The water level typically rises with inhalation and falls with exhalation, reflecting natural pressure changes within the chest cavity. Tidaling confirms the chest tube is open and connected to the pleural space, and that the lung has not yet fully re-expanded. If tidaling is not observed, it could suggest a kink in the tubing, a blockage, or that the lung has fully re-expanded.
Continuous bubbling in the water seal chamber is generally not a normal finding and often indicates an air leak, meaning air is constantly escaping from the pleural space or there is a leak within the drainage system itself. While expected immediately after chest tube placement for a collapsed lung, its sudden onset or persistence usually signals a new issue requiring investigation.
Common Causes of Continuous Bubbling
Continuous bubbling indicates an air leak, which can originate from the patient or the drainage system. Differentiating the source is important for appropriate response.
A patient-related air leak means air is persistently escaping from the lung or airways into the pleural space. This can occur due to lung injury (e.g., from trauma or surgery) or a bronchopleural fistula, an abnormal connection. When air leaks from the lung, it enters the pleural space and is removed by the chest tube. Such leaks can prevent full lung re-expansion and may prolong hospital stays.
More commonly, continuous bubbling stems from a system-related air leak. These are often easier to identify and resolve. Common issues include loose connections, allowing outside air to enter the system, or damage to the drainage unit itself, such as a crack. A hole in the tubing or a dislodged chest tube can also cause continuous bubbling, though dislodgement often has other signs.
What to Do About Continuous Bubbling
If continuous bubbling is observed, assess the entire chest tube system. Start from the patient’s insertion site and work down to the drainage unit. Check all connections for disconnections, loose fittings, or kinks, as these are common and often easily fixable sources of air leaks. Ensure the drainage unit remains upright and below the patient’s chest level.
Concurrently, observe the patient for any changes in condition, such as increased shortness of breath, chest pain, rapid breathing, or signs of distress. These could indicate a serious underlying problem. If bubbling cannot be resolved by checking connections or if there are concerning patient symptoms, notify healthcare professionals immediately. Medical evaluation is always warranted to determine the cause and appropriate management.
Never clamp the chest tube without specific instructions from a medical professional. Clamping a chest tube with an ongoing air leak can trap air in the pleural space, potentially leading to tension pneumothorax, which can severely affect breathing and circulation. Healthcare providers have specific protocols for assessing and managing air leaks, which may involve temporary clamping under controlled circumstances to locate the leak.