A chest tube is a flexible, hollow catheter inserted into the space between the lung and the chest wall, known as the pleural space. Its primary purpose is to drain unwanted air, fluid, or blood that has accumulated, which can otherwise cause a lung to collapse or impair its function. Observing for bubbling offers important insights into the patient’s condition.
How Chest Drainage Systems Work
A chest drainage system is a sealed unit designed to remove substances from the pleural space and prevent their re-entry. These systems typically consist of three main components: a collection chamber, a water seal chamber, and a suction control chamber. The collection chamber gathers any drained air or fluid, often with calibrated markings for measurement.
The water seal chamber is a crucial part of the system, acting as a one-way valve. It contains sterile water, typically filled to a 2 cm mark, which allows air to exit the pleural space during exhalation but prevents outside air from re-entering during inhalation. This chamber is where bubbling is observed. The suction control chamber regulates the amount of negative pressure applied to the system.
Interpreting Bubbling in the Water Seal Chamber
The pattern of bubbling in the water seal chamber provides important information about the patient’s condition and the chest drainage system’s function. Bubbling indicates that air is moving through the system, and understanding these patterns is essential for proper assessment.
Intermittent bubbling, appearing and disappearing with the patient’s breathing, coughing, or sneezing, is typically a normal and expected finding. This indicates air is being expelled from the pleural space as the lung re-expands or as residual air from a pneumothorax is removed. The bubbling may increase with exhalation or when the patient coughs, reflecting increased pressure in the chest.
Continuous bubbling in the water seal chamber usually signifies an air leak. This means air is constantly escaping from the pleural space, or there is a leak somewhere within the chest drainage system itself. While continuous bubbling can be expected initially if a chest tube was placed for a pneumothorax, its sudden onset or persistence after initial resolution often indicates a new or worsening issue that requires investigation.
The absence of bubbling can have several meanings. If bubbling was previously present, its cessation might indicate that the air leak has resolved and the lung has fully re-expanded. However, it could also mean the chest tube is kinked, clotted, or that the system is no longer patent, preventing air or fluid from draining. If bubbling suddenly stops when an air leak was known to be present, it requires careful assessment of the patient and the entire drainage system.
Identifying the Source of an Air Leak
When continuous bubbling suggests an air leak, healthcare professionals follow a systematic approach to pinpoint its origin. An air leak can stem from the patient’s chest, the chest tube insertion site, the tubing connections, or the drainage unit itself.
A common method involves temporarily clamping the chest tube. If clamping the tube close to the patient’s chest causes the bubbling to stop, it suggests the air leak is coming from the patient’s lung or the insertion site. If bubbling continues after clamping near the patient, the clamp is systematically moved down the tubing towards the drainage system. When the bubbling stops, the leak’s location is identified as being between that clamp and the previous point.
Leaks at the insertion site might be managed by reinforcing the dressing, sometimes with petroleum gauze to create a seal. Loose tubing connections are often secured with tape or fasteners. If the leak persists after checking these external points, it suggests the air leak is internal, originating from the lung itself, possibly due to an unresolved pneumothorax or a new lung injury. If bubbling continues even when the entire tubing system is clamped, the drainage unit itself may be defective and require replacement.
Important Considerations and When to Seek Help
Recognizing significant changes in chest tube bubbling is important for patient care. While intermittent bubbling is a normal indication of air removal, any new or sudden continuous bubbling, especially if it’s vigorous, warrants immediate attention. Similarly, if bubbling abruptly stops when an air leak was expected or previously present, this also requires prompt assessment.
Changes in a patient’s condition, such as increased shortness of breath, chest pain, or rapid breathing, alongside changes in bubbling patterns, are important indicators. Other concerns include visible issues with the chest tube itself, such as dislodgement, kinking of the tubing, or a break in the drainage system’s integrity. These situations can compromise the chest tube’s function and lead to complications.
It is important to avoid adjusting the chest tube or the drainage system without guidance from a healthcare professional. Healthcare professionals are trained to assess the situation, identify problems, and implement appropriate interventions to ensure patient safety and effective chest tube function.