Four Way Bottle System

Alabastro - Andrada Casillan Siobal Soriano

BSN III - A
THE CHEST TUBE

A chest tube is a flexible plastic tube that is inserted through the

chest wall and into the pleural space or mediastinum. It is used to
remove air in the case of pneumothorax or fluid such as in the
case of pleural effusion, blood, chyle, or pus when empyema
occurs from the intrathoracic space. It is also known as a Blau
drain or an intercostal catheter. Insertion of chest tubes is widely
performed by radiologists, pulmonary physicians and thoracic
surgeons.
Chest drainage system

The aims for an adequate chest drainage system to be fulfilled are:

(I) remove fluid & air as promptly as possible;
(II) prevent drained air & fluid from returning to the pleural space, restore
negative pressure in the pleural space to re-expand the lung.
Thus, a drainage device must:
(I) allow air and fluid to leave the chest;
(II) contain a one-way valve to prevent air & fluid returning to the chest; (III)
have design so that the device is below the level of the chest tube for gravity
drainage.
An underwater seal chest drainage system is used to restore proper air pressure
to the lungs, re-inflate a collapsed lung as well as remove blood and other
fluids.
Indications for insertion

a collapsed lung
a lung infection
bleeding around your lung, especially after a trauma (such as a car
accident)
fluid buildup due to another medical condition, such as cancer
or pneumonia
breathing difficulty due to a buildup of fluid or air
surgery, especially lung, heart, or esophageal surgery
Indications for removal

Absence of an air leak (pneumothorax)

Drainage diminishes to little or nothing
No evidence of respiratory compromise
Chest x-ray showing lung re-expansion
Insertion Procedure

Generally, chest tubes to drain air are placed high and anterior
whereas chest tubes to drain fluid are placed low and directed
posteriorly.
The distal end of the test tube is clamped and using the clamp as
a guide, inserted into the incisional site. At this time, the patient
should be encouraged to take a deep breath; this will displace the
diaphragm downward, minimizing the risk of its injury. The clamp
is removed and the tube is then advanced into the pleural space
and directed anteriorly or posteriorly depending on the material
being drained.
 Tubing from the test tube must not be allowed to form any dependent loops as
drainage problems and tube obstruction may occur. The tubing should be coiled
flat on the bed and from there fall in a straight line to the chest drainage
system.
Additionally, when the patient is in bed, a semi sitting position will promote
drainage; so will turning the patient toward the side of the chest tube and
having him periodically exhale and cough.
Four way Bottle System
Bottle 1: Fluid Collection. This is a simple
collection bottle that connects directly to your
chest tube. Look here to see how much blood
youve collected from your hemothorax, or
fluid from your pleural effusion, or pus from
your empyema.
This is where drainage from the chest will
accumulate. It can hold up to 2000cc.
Bottle 2: Water Seal (unvented) This is a more
complicated setup that allows you to detect air from
your pneumothorax (or from a leak due to equipment
failure). To conceptualize this, imagine a straw
submerged in a glass of water. If you blow air into the
straw, bubbles will come out. Intermittent bubbles mean
that theres interrupted air flow, and continuous bubbles
mean that theres continuous air flow. However, if you
try to suck on the straw, only water will come up and
not air. This is another way of describing a one-way
valve: air can escape the chest, but it cant come back
in.
Bottle 3: Suction Control. This is the
fanciest bottle of all, and includes a
manometer that allows you to deliver
controlled suction through your chest tube.
Fancy versions (like the Atrium Oasis
3600 stocked at Mount Sinai) also
incorporate dials and bellows to allow you
to turn the suction up and down. There are
even fancier systems with dual collection
chambers and all sorts of other snazziness.
Bottle 4: Water Seal (Auxiliary vented):
This fourth chamber serves as a positive
pressure safely relief valve should the
suctions become inoperative or if the suction
tubing becomes occluded or kinked. In
addition, it is a second water seal and
manometer, estimating negative pressure in
the drainage bottle and pleural space.
Chest tube drainage system in actual set up
THANK YOU