chest tube

Three-Bottle System

Traditional setup combining collection, water seal, and suction control; safest when controlled suction is needed.

First Bottle – Collection Chamber

Collects pleural drainage (blood, pus, effusion); graduated for accurate measurement.

Second Bottle – Water-Seal Chamber

One-way valve with ~2 cm sterile water; lets air out but prevents re-entry; bubbling

Third Bottle – Suction Control Chamber

Regulates negative pressure via water column.

Wet Suction Control

Uses water-filled chamber to regulate suction; set at 20 cm H₂O.

Dry Suction Control

Uses mechanical regulator/dial; set to −20 cm H₂O; no bubbling observed.

Accidental Tube Removal

Cover site with sterile occlusive dressing taped on 3 sides (allows air escape, prevents entry).

Tube Malposition/Blockage

Signs: no tidaling, absent drainage, worsening dyspnea, absent breath sounds.

Persistent Air Leak

Continuous bubbling in water-seal chamber.

Accidental Disconnection

Place tube end in sterile water, reconnect with sterile technique, notify provider.

Subcutaneous Emphysema

Swelling with “crackling” (crepitus) sensation on palpation.