Chest Tube Physiology Review

Summary

This ICU Advantage video lesson, hosted by Eddie Watson, delves into the physiology behind chest tubes, essential for healthcare professionals in the ICU. The video explains the normal functioning of the pleural space and how disruptions such as pneumothorax, hemothorax, and pleural effusion necessitate chest tube placement. It covers the pathophysiology of these conditions, the goals of chest tube insertion, and the mechanics of chest tube systems, including the transition from traditional three-bottle setups to modern, streamlined devices, emphasizing safety and efficiency in patient care.

Takeaways

• 😀 Eddie Watson from ICU Advantage aims to simplify complex critical care subjects to help ICU staff succeed.
• 📚 The lesson focuses on the foundational physiology behind chest tubes and their clinical applications.
• 💡 Normal pleural space physiology involves a balance of pressures with the lungs' elastic recoil and the chest wall's outward force creating a negative intrapleural pressure.
• 🌪️ Disruptions in pleural space pressure, such as pneumothorax, hemothorax, and pleural effusion, can lead to respiratory compromise and the need for chest tubes.
• 🩺 Chest tubes are used to restore normal physiology by evacuating air, blood, or fluid from the pleural space and re-expanding the lung.
• 🚫 Chest tubes must prevent air from re-entering the pleural space, which would counteract the therapeutic effect.
• 💧 The traditional chest tube setup included a three-bottle system with drainage, water seal, and suction components to manage air and fluid evacuation.
• 🔄 Modern chest tube collection devices have simplified the process, combining the functions of the three-bottle system into a single, safer, and more efficient unit.
• 📉 The water seal in the chest tube system acts as a one-way valve, allowing air and fluid to exit but preventing air from re-entering the pleural space.
• 🌀 Active suction can be applied to the chest tube system to enhance the evacuation of air, blood, or fluid from the pleural space.
• 🛠️ The level of suction applied to the chest tube can be controlled and adjusted to ensure patient safety and effective treatment.

Q & A

What is the main purpose of a chest tube?

The main purpose of a chest tube is to evacuate air, blood, or fluid from the pleural space, restore the normal negative intrapleural pressure, and allow the lung to re-expand, ultimately helping to heal the injury that caused the condition.

What are the three main disruptions in the normal process of breathing that can lead to the need for a chest tube?

The three main disruptions are pneumothorax (air in the pleural space), hemothorax (blood in the pleural space), and pleural effusion (fluid accumulation in the pleural space).

What is the normal function of the pleural space in relation to lung function?

The pleural space, located between the visceral and parietal pleura, maintains a relatively negative intrapleural pressure compared to atmospheric pressure, which helps keep the lungs expanded against the chest wall and facilitates lung function.

What is transpulmonary pressure and how does it relate to lung expansion?

Transpulmonary pressure is the difference between intrapulmonary pressure and intrapleural pressure. It is a pressure gradient that, when positive (intrapulmonary pressure higher than intrapleural pressure), causes the lungs to expand against the chest wall.

How does a pneumothorax disrupt normal lung function?

A pneumothorax introduces air into the pleural space, which can equalize the pressures and eliminate the transpulmonary pressure gradient. This results in the lung collapsing, leading to impaired gas exchange and symptoms like dyspnea and hypoxia.

What is the role of the water seal in a chest tube setup?

The water seal acts as a one-way valve in the chest tube setup, preventing air from re-entering the pleural space while allowing air, blood, and fluid to be evacuated from the pleural space.

Why is a two-bottle system used in chest tube management?

A two-bottle system is used to separate the drainage from the water seal, allowing for continuous drainage collection without altering the hydrostatic pressure in the water seal, which is crucial for maintaining the one-way valve function.

What is the purpose of adding suction to a chest tube setup?

Adding suction to a chest tube setup helps to actively pull air, blood, and fluid out of the pleural space faster, improving drainage efficiency in cases where there is a large volume of accumulation.

How does a modern chest tube collection device simplify the traditional three-bottle system?

A modern chest tube collection device combines the functions of the drainage bottle, water seal, and suction control into a single unit, making it easier to set up, reducing the risk of disconnection or leaks, and maintaining the safety and efficiency of the chest tube system.

What is the typical amount of suction applied in a chest tube setup and why is it commonly used?

The typical amount of suction applied is negative 20 centimeters of water. This level of suction is commonly used because it provides effective drainage without causing excessive or potentially traumatic suction on the patient's lung tissue.