Three-Bottle System

Three-Bottle System

The most commonly used traditional chest drainage setup

Three-Bottle System

Combines fluid collection, a one-way water seal, and suction control

Three-Bottle System

Considered safer and more effective than the one- or two-bottle systems, especially when controlled suction is needed. Three-Bottle System – Mechanism of Action

Three-Bottle System – Mechanism of Action

Air passes through the water-seal chamber, escaping safely but not returning

Three-Bottle System – Mechanism of Action

Controlled suction is applied via the third bottle, helping re-expand the lung while preventing excessive negative pressure that could damage lung tissue. Three-Bottle System – First Bottle (Collection Chamber)

Three-Bottle System – First Bottle (Collection Chamber)

Graduated for accurate measurement. Three-Bottle System – Second Bottle (Water-Seal Chamber)

Three-Bottle System – Second Bottle (Water-Seal Chamber)

Typically contains ~2 cm of sterile water

Three-Bottle System – Second Bottle (Water-Seal Chamber)

Bubbling in this chamber indicates air is leaving the pleural space. Three-Bottle System – Third Bottle (Suction Control Chamber)

Chest Tube System Analogy

Drainage system

Chest Tube System Analogy

Suction

Suction Control Types

Wet suction — uses water to regulate the suction level

Suction Control Types

Dry suction — uses a mechanical regulator/dial. Wet Suction Control

Wet Suction Control

The water level in the suction-control chamber is set at 20 cm H₂O. Dry Suction Control

Dry Suction Control

Ordered suction: the nurse sets the suction-control dial to −20 cm H₂O. Wet Suction – Suction Regulation

Dry Suction – Suction Regulation

Mechanical regulator/dial

Wet Suction – Uses Water for Suction Control

Yes

Dry Suction – Uses Water for Suction Control

No

Wet Suction – Example Setting

−20 cm H₂O

Dry Suction – Example Setting

−20 cm H₂O

Wet Suction – Bubbling in Suction-Control Chamber

Usually gentle bubbling

Dry Suction – Bubbling in Suction-Control Chamber

Usually no bubbling required

Wet Suction – Requires Suction Source When Suction Is Ordered

Yes

Dry Suction – Requires Suction Source When Suction Is Ordered

Yes

Wet Suction – Main Nursing Concern

Maintain correct water level

Dry Suction – Main Nursing Concern

Verify correct dial/indicator setting. Three-Bottle System Nursing Responsibilities (Collection Bottle/1st Bottle)

Three-Bottle System Nursing Responsibilities (Collection Bottle/1st Bottle)

Monitor drainage color

Three-Bottle System Nursing Responsibilities (Collection Bottle/1st Bottle)

Monitor drainage consistency (serous, sanguineous, purulent)

Three-Bottle System Nursing Responsibilities (Collection Bottle/1st Bottle)

Mark level at regular intervals (e.g., every shift)

Three-Bottle System Nursing Responsibilities (Collection Bottle/1st Bottle)

Report abnormalities: sudden increase → possible hemorrhage

Three-Bottle System Nursing Responsibilities (Collection Bottle/1st Bottle)

Report abnormalities: sudden stop → tube may be blocked or kinked. Three-Bottle System Nursing Responsibilities (Water-Seal Bottle/2nd Bottle)

Three-Bottle System Nursing Responsibilities (Water-Seal Bottle/2nd Bottle)

Observe for bubbling: intermittent bubbling → normal (air leaving pleural space)

Three-Bottle System Nursing Responsibilities (Water-Seal Bottle/2nd Bottle)

Observe for bubbling: continuous bubbling → air leak (check tubing and insertion site)

Three-Bottle System Nursing Responsibilities (Water-Seal Bottle/2nd Bottle)

Observe for tidaling (water oscillation): indicates tube patency

Three-Bottle System Nursing Responsibilities (Water-Seal Bottle/2nd Bottle)

Absence of tidaling may mean lung has re-expanded or tube is blocked. Three-Bottle System Nursing Responsibilities (Suction Control Bottle/3rd Bottle)

Three-Bottle System Nursing Responsibilities (Suction Control Bottle/3rd Bottle)

Gentle bubbling should be present → indicates suction is working

Three-Bottle System Nursing Responsibilities (Suction Control Bottle/3rd Bottle)

Excessive bubbling → water may evaporate quickly, noise, or unnecessary suction

Three-Bottle System Nursing Responsibilities (Suction Control Bottle/3rd Bottle)

Check water level regularly and refill with sterile water if evaporation occurs. Three-Bottle System Nursing Responsibilities (Tubing & System Care)

Three-Bottle System Nursing Responsibilities (Tubing & System Care)

Connections must be secure and airtight

Three-Bottle System Nursing Responsibilities (Tubing & System Care)

Do not strip/milk the tube aggressively (can cause high negative pressure)

Three-Bottle System Nursing Responsibilities (Tubing & System Care)

Keep system upright and below chest level at all times. Three-Bottle System Nursing Responsibilities (Patient Monitoring)

Three-Bottle System Nursing Responsibilities (Patient Monitoring)

Watch for signs of distress (dyspnea, tachypnea, cyanosis, subcutaneous emphysema, mediastinal shift)

Three-Bottle System Nursing Responsibilities (Patient Monitoring)

Check insertion site & dressing for bleeding, leakage, or infection

Three-Bottle System Nursing Responsibilities (Patient Monitoring)

Encourage deep breathing, coughing, and position changes to promote drainage and lung expansion. Three-Bottle System Nursing Responsibilities (Safety Precautions)

Three-Bottle System Nursing Responsibilities (Safety Precautions)

If system breaks → place tube end in sterile water to recreate a water seal

Three-Bottle System Nursing Responsibilities (Safety Precautions)

Do not clamp the chest tube routinely (risk of tension pneumothorax)

Three-Bottle System Nursing Responsibilities (Safety Precautions)

Ensure emergency equipment (oxygen, suction, resuscitation) is available. Three-Bottle System Nursing Responsibilities (Documentation)

Three-Bottle System Nursing Responsibilities (Documentation)

Record patient's respiratory assessment

Three-Bottle System Nursing Responsibilities (Documentation)

Record function of water seal & suction control

Three-Bottle System Nursing Responsibilities (Documentation)

Record any interventions performed. Three-Bottle System Advantages

Three-Bottle System Advantages

Allows both fluid and air drainage

Three-Bottle System Advantages

Permits controlled suction, which speeds up lung re-expansion

Three-Bottle System Advantages

Effective monitoring: bubbling in water-seal chamber → air leak present

Three-Bottle System Advantages

Effective monitoring: bubbling in suction control chamber → suction functioning. Three-Bottle System Limitations

Three-Bottle System Limitations

Bulky and less portable

Three-Bottle System Limitations

Risk of water evaporation in the suction control chamber (needs monitoring)