Introduction
Respiratory distress is a life-threatening condition characterized by the lungs’ inability to deliver sufficient oxygen to the body’s organs due to disruption of the negative pressure in the pleural cavity. The disruption occurs when air or fluid enters the cavity between the parietal and visceral pleura, preventing the lungs from appropriate expansion. While small amounts of air or fluid are generally absorbed, larger amounts may cause substantial health problems; chest tubes are used to drain them. This paper examines when chest tube administration was first used, how it is applied in modern clinical settings, and what patients should know about it.
Description of the Procedure
Thoracic catheters, thoracostomy tubes, or chest tubes are sterile silicone or PVC tubes with multiple drainage holes. As part of a drainage system, they aim to restore disrupted negative pleural pressure, ensure lung re-expansion, and optimize oxygenation (Porcel, 2018). The placement of the tube depends on its function – in particular, it is placed near the lung’s apex anteriorly to drain air, near the lung’s base to drain fluid, or at the apex or base if both fluid and air are present.
A drainage system commonly has three main chambers: the collection chamber, the water-seal chamber, and the suction control chamber (Porcel, 2018). The collection chamber drains air or fluid from the pleural space attached to the chest tube. With a one-way valve, the water-seal chamber allows air or fluid to exit the cavity but prevents re-entering. The suction control chamber controls fluid or air flow from the pleural cavity, overcoming an air leak.
Currently, there are two types of suction control chambers: wet and dry suction drainage chambers. In the first system, which is regarded as a traditional one, negative pressure in the pleural cavity is controlled by the water level, and its evaporation lowers the pressure. Meanwhile, dry suction of the digital drainage system is a relatively new self-regulating technology in which sensors control pleural pressure and air flow. In addition, there is a Heimlich valve, another portable and mobile tool for releasing air or fluid from the pleural space if the drainage system is unavailable (Porcel, 2018). Attached to the chest tube and a drainage bag, it allows for efficient patient assistance, preventing air backflow.
History of Chest Tube Administration
In general, the use of chest tubes had already been practiced in ancient times. The process was initially described in the 6th century BC, the time of Hippocrates, when metal tubes were applied to treat empyema. However, the first water-sealed chest drainage system was used by Playfair in 1873. In the early 20th century, during the flu epidemic and later during World War II, chest tube administration, especially tube placement techniques, evolved and developed. In the present day, along with traditional wet suction drainage systems and Heimish valves, digital dry drainage systems are applied as the most innovative.
Evidence-Based Practice
In modern clinical settings, chest tubes and drainage systems are crucial in patients’ treatment and life-saving. They are required for spontaneous, traumatic, and tension pneumothorax, hemothorax, pleural effusion, empyema, and cardiac tamponade. According to Dhanasopon et al. (2021), chest tube thoracostomy was essential for patients with COVID-19 who required invasive mechanical ventilation due to acute respiratory distress syndrome.
Mechanical ventilation frequently leads to barotrauma and associated pneumothorax or pleural effusion, which necessitates chest tube administration. At the same time, new technologies related to it are constantly evaluated – thus, in the present day, the digital chest drainage system is regarded as the most efficient one (Chang et al., 2022; Wang et al., 2019). It ensures faster recovery, improved life quality, and minimized risks of postoperative complications in patients after surgeries.
Health Teaching Information
As chest tube thoracostomy is an invasive technique, a nurse needs to ensure that a patient receives all essential information and is aware of all stages of the process to decrease their stress and anxiety. First, a nurse should articulate the necessity of chest tube administration and its details, using the most understandable words and avoiding specific terms (Astle & Duggleby, 2018). In addition, she should ensure a patient’s understanding by asking subject-related but straightforward questions. Finally, a healthcare provider should demonstrate competence in relation to the procedure and explain the significance of its vital aspects, such as sterility and hygiene, to educate and comfort a patient at the same time.
Conclusion
A chest tube is part of a drainage system that reestablishes normal negative pressure within the pleural cavity when the body cannot absorb air or fluid to prevent respiratory distress. While tubes have been applied since ancient times, modern techniques include traditional wet suction drainage systems, modern digital systems, and Heimish valves. They are essential for treating and saving patients with hemothorax, pneumothorax, empyema, pleural effusion, and cardiac tamponade. At the same time, while chest tube administration is an invasive procedure, health care providers are responsible for educating patients to release stress and ensure positive outcomes.
References
Astle & Duggleby (Eds.). (2018). Canadian fundamentals of nursing (6th ed). Elsevier.
Chang, P. C., Chen, K. H., Jhou, H. J., Lee, C. H., Chou, S. H., Chen, P. H., & Chang, T. W. (2022). Promising effects of digital chest tube drainage system for pulmonary resection: A systematic review and network meta-analysis. Journal of Personalized Medicine, 12(4), 512.
Dhanasopon, A. P., Zurich, H., & Preda, A. (2021). Chest tube drainage in the age of COVID-19. Physician Assistant Clinics, 6(2), 261-265.
Porcel, J. M. (2018). Chest tube drainage of the pleural space: A concise review for pulmonologists. Tuberculosis and Respiratory Diseases, 81(2), 106-115.
Wang, H., Hu, W., Ma, L., & Zhang, Y. (2019). Digital chest drainage system versus traditional chest drainage system after pulmonary resection: A systematic review and meta-analysis. Journal of Cardiothoracic Surgery, 14(1), 1-6.