A chest tube is a flexible, hollow tube inserted into the space between the lung and the chest wall, known as the pleural space. This medical device serves to remove unwanted air, fluid, or blood that may accumulate in this area. The primary purpose of a chest tube is to re-establish the normal negative pressure within the pleural space, which is necessary for the lungs to fully expand and function properly.
The Role of a Chest Tube
A chest tube is inserted to address conditions that disrupt lung function by causing a buildup in the pleural space. These include pneumothorax (air), hemothorax (blood), pleural effusion (fluid), or empyema (pus). The tube connects to a drainage system with a collection chamber and a water seal, acting as a one-way valve. Suction may also be applied to aid drainage and lung re-expansion.
Interpreting Bubbling in the Water Seal Chamber
Observing bubbling in the water seal chamber of a chest tube drainage system provides important information about the patient’s condition and the system’s function. The presence and pattern of bubbling can indicate whether air is still leaking from the lung or if there is a leak within the drainage system itself. The water seal acts as a visual indicator for air escaping the pleural space.
Intermittent bubbling, especially during exhalation, coughing, or deep breaths, is a normal finding. It indicates air is successfully leaving the pleural space through the chest tube, common with pneumothorax as the lung re-expands. As the lung heals and re-expands, the amount of intermittent bubbling should gradually decrease.
Continuous bubbling in the water seal chamber can signify a persistent air leak from the lung or within the system. Initially, continuous bubbling may be expected if a significant air leak was present. However, a sudden appearance or increase in continuous bubbling suggests a new or worsening air leak from the lung, or a disconnection or leak within the tubing or drainage unit. Identifying the source of a continuous leak is important, often involving checking all connections and the insertion site.
Conversely, the complete absence of bubbling, especially when an air leak was expected, can be a significant observation. This indicates the lung has fully re-expanded and the air leak has resolved. However, a sudden cessation of bubbling might also signal a problem such as a kink, clot, or dislodged tube, preventing proper drainage.
Beyond Bubbling: Other Signs to Watch For
Beyond bubbling, tidaling is another important sign. This is the normal fluctuation of the water level in the water seal chamber with each breath. It reflects pressure changes within the pleural space, confirming the tube is open and connected. If tidaling is not observed, it could mean the lung has re-expanded or indicate a kink or blockage.
The characteristics of the fluid collected in the drainage chamber are important. Observe the color, amount, and consistency of the drainage for healing information. Changes like clear to bloody fluid, or increased volume, should be noted. Also observe the insertion site for redness, swelling, or new pain.
When to Contact a Healthcare Provider
Prompt communication with a healthcare provider is important if certain changes are observed with a chest tube. Report a sudden onset of continuous bubbling, or a significant increase in existing continuous bubbling. Similarly, a sudden stop in bubbling or tidaling, especially if an air leak or drainage was anticipated, should be reported.
Communicate any significant increase in drainage volume, especially if bright red or changed in consistency. If the chest tube dislodges or disconnects, seek immediate medical assistance. Signs of infection at the insertion site, such as increased pain, redness, swelling, or pus, require prompt evaluation. Worsening shortness of breath, new or increased chest pain, or dizziness should be reported immediately.