![]() ![]() ![]() If the lung is fully inflated, the suction can be adjusted to the lowest amount needed to maintain lung inflation, although care should be taken with continuous air leaks (ideally with the elimination of suction). If an air leak gauge is not available, then one can assess for continuous versus intermittent air leaks. It does not indicate flow in any precise manner but can provide an indication of any day-to-day increases or decreases in the degree of air leak. (See "Overview of pulmonary resection", section on 'Chest tube placement and management'.)Īir leak monitor - The number of columns (eg, 1 to 7) that are bubbling in the air leak gauge ( figure 1A-B) of a wet suction-controlled, closed-drainage system provides a semiquantitative measure of the severity of the leak. Following lung resection surgery, whether ongoing suction applied to the thoracostomy tube improves or worsens pleural leaks is controversial.If after fluid has been fully drained there is concern for a pneumothorax but no air leak, increasing the level of suction is not warranted. Sometimes the lung is trapped, and if this occurs, increasing suction can be detrimental. When the thoracostomy tube or catheter is placed for fluid drainage, the level of suction should be increased, as indicated, from the initial setting (eg, -20 cm of water) with the goal of achieving full lung expansion as determined by the chest radiograph.A persistent air leak without complete re-expansion is the usual reason for applying (or increasing) suction. For incomplete resolution of the pneumothorax, suction may be added or increased, as needed, as determined by the chest radiograph. For spontaneous air leaks, maintaining the least amount of suction (including none ) to maintain full expansion of the lung is appropriate.Suggested suction levels are given below: The level of continuous suction and its use depends upon the indication. ![]() The typical level of continuous suction used in the clinical setting is -10 to -20 cm H 2O of water (adult and pediatric populations), which can be adjusted upward or downward if there is failure to drain or improvement respectively. Level of ongoing suction - Commercial closed-drainage systems typically allow the suction level to be adjusted between 0 and -40 cm of water. (See "Thoracostomy tubes and catheters: Placement techniques and complications", section on 'Re-expansion pulmonary edema'.) This feature can be used if the patient develops chest pain as a result of too rapid an evacuation of large pneumothoraces or pleural effusions. Thoracostomy tube or catheter drainage systems usually incorporate a pressure release valve that rapidly equilibrates the collection chamber pressure with atmospheric pressure without disconnecting the suction tubing. It is important that the fluid container be placed below the catheter to avoid inadvertent suction of fluid into the pleural space. Ad hoc ("improvised") systems can be used as a temporary measure, with sterile water in a small container to mimic a water seal, without suction. Other closed-suction systems are available that allow the patient to be mobile ( figure 2). The configuration and function of a typical wet-control, closed-drainage system (eg, Pleur-evac) is detailed in the figure ( figure 1A-B). (See "Thoracostomy tubes and catheters: Indications and tube selection in adults and children" and "Thoracostomy tubes and catheters: Placement techniques and complications".)ĭRAINAGE SYSTEMS - Following placement of a thoracostomy tube or catheter, wet or dry suction control, closed-drainage systems are typically used, and each is effective. Specific medical and surgical conditions that result in the need to perform thoracostomy for pleural drainage, and techniques for placement are reviewed separately and discussed in more detail in separate topic reviews. The management of thoracostomy tubes or catheters is reviewed. Thoracostomy catheters can be placed over a wire using a Seldinger technique (ie, "percutaneously placed thoracotomy tubes"). We use "thoracostomy catheter" to refer to smaller diameter thoracostomy tubes (≤14 Fr) and more flexible opaque specialty devices (eg, pigtail). INTRODUCTION - Thoracostomy tubes or catheters placed in hospitalized patients require daily assessment to determine the presence of air leak, provide ongoing adjustment of suction level, and to monitor for malfunction, which may include obstruction, malposition, or disconnection.įor the purposes or our discussion, we use "thoracostomy tube" to refer to traditional tubes, which are clear with longitudinal markers and are generally stiffer and with larger diameter thoracostomy tubes (≥16 French ) requiring a surgical incision for placement (ie, "surgically placed thoracostomy tubes"). ![]()
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