CHEST DRAINAGE
PRODUCT TRAINING COURSE
Richard Švec, M.D.
Training overview
• Anatomy, physiology and mechanics of
breathing
• Pneumothorax, Haemothorax
• Principles of underwater seal chest
drainage
• From the bottle system to CDU
• Chest drainage products (features and
benefits)
Anatomy of the Chest Cavity
Trachea
Left Lung
Right Lung
Mediastinum
Diaphragm
Pericardium
Intrapleural
space
Intrapleural
space
Intrapleural Space
Visceral
pleura
Chest
wall
Lung
Zoom
Parietal
pleura
Intrapleural space
Principles of Respiration
The pressure of a given quantity of gas
is inversely proportional to its volume.
Principles of Respiration
Increasing volume causes a decrease in pressure, which
causes air to rush in as the pressures reach equilibrium.
Principles of Respiration
Decreasing volume causes an increase in pressure, which
causes air to be expelled as pressures reach equilibrium.
The Lungs
Passive organ (can not make any
movements by itself)
Needs to be expanded to work
Expansion of the lungs is achieved by:
• Negative intrapleural pressure
• Lung surface tension
Air inlet/outlet into/from lungs is
achieved by:
• Increase/Decrease of the volume of the
chest cavity (Boyle´s law)
Mechanics of Respiration
Inspiration process
Air in
Contraction of diaphragm
and intercostal muscles
Increase of the negative
intrapleural presure
Expansion of the lungs
Air inlet to lungs
Mechanics of Respiration
Expiration process
Air out
Relaxation of diaphragm
and intercostal muscles
Decrease of the negative
intrapleural presure
Relaxation of the lungs
Air outlet from lungs
Abnormal Conditions
• Violation of the closed system of the thoracic cavity
• Loss of the negative intrapleural pressure
• Accumulation of air in the intrapleural space
• Accumulation of fluid in the intrapleural space
!
PARTIAL OR FULL LUNG COLLAPSE
DIMINISHED RESPIRATION
TREATMENT NEEDED
!
Terminology
Pneumothorax
• accumulation of air in the pleural space
Haemothorax
• accumulation of blood in the pleural space
Haemopneumothorax
• accumulation of air and blood in the pleural space
Fluidothorax
• accumulation of any other fluid (matter) in pleural
space
Haemomediastinum
• accumulation of blood in mediastinum
Pneumothorax
• External pneumothorax
Opening in the chest wall. Air directly enters and
leaves the intrapleural space - open communication.
Loss of negative intrapleural pressure. 0
• Internal pneumothorax
Opening in the lung. Air enters and leaves intrapleural
space through lung. Loss of negative intrapleural
pressure. 0
•Tension pneumothorax (Valve pneumothorax)
Opening in the lung or chest wall. Air enters the
intrapleural space but can not leave out. Building of
possitive intrapleural presure. (+) !!!!!!
Pneumothorax
Opening in chest wall
Trauma, operation
AIR
Opening in the chest
wall
Open
communication
Loss of the negative intrapleural pressure
Collapse of the lungs
Tension Pneumothorax
Trauma
One way (valve)
Opening in lung
Opening in the lung
Loss of the negative
intrapleural pressure
Collapse of the lungs
Risk of building of positive intrapleural presure
!!
AIR
Pneumothorax, Haemothorax
Objectives of treatment
• Removal of air
• Removal of fluid
• Re-building of negative intrapleural pressure
Lung re-expansion
Pneumothorax, Haemothorax
Method of treatment
UNDERWATER SEAL
THORACIC DRAINAGE
Underwater Seal
Chest drainage
To the drainage
system
•Provides means for air
and fluid to escape the
chest cavity
•Prevents air from reentering the pleural space
•Re-establishes
intrapleural negative
pressure
•Re-expands the lungs
One bottle system
From patient
Air out
For small pneumothorax
use only !
Risk of progressive resistance building by
haemothorax.
Water seal
No control of the situation
in the chest cavity.
Two bottle system
From patient
Air out
Collection
bottle
Separation of water seal
and collection in 2 bottles
elliminates the risk of
progressive resistance
building.
No active suction conection recommended.
Limited information about
the situation in the chest
cavity
Water seal
Three bottle system
Active suction
From patient
Suction control
bottle
Collection
bottle
Water seal
Three bottle system
• Separated collection, underwater seal and suction
control bottle
• No risk of progressive resistance building
• Exact active suction control
• Limited information about the situation inside the
chest cavity
Four bottle system
From patient
Active
suction
Patient
assesment
bottle
Collection Water seal
bottle
bottle
Suction control
bottle
Four bottle system
From patient
Active
suction
Patient
assesment
bottle
Collection Water seal
bottle
bottle
Suction control
bottle
Four bottle system
• Separated collection, underwater seal, suction
control and patient assesment bottles
• No risk of progressive resistance building
• Exact active suction control
• Exact information about the situation inside
the chest cavity
•Complicated to
assemble and
connect to patient
•Problem to
transport
•Made from vulnerable material
•Difficult to monitor
IMPROVEMENT
NEEDED
Bottle systems
From bottles to CDUs
Patient
3Ch.CDU system
Active
suction
Suction
control
chamber
Collection
chamber
Underwater seal chamber
TYCO Healthcare offers
complete line of the chest
drainage units
THORA SEAL I
• Analogy of the one
bottle concept
• For pneumothorax
only
• Compact, easy to use
• Disposable, break
resistant
• for gravity drainage
only
• Self contained floor
stand
• Ready to use
THORA SEAL II
•Analogy of the two bottle
concept
•Separated underwater
seal chamber and 2,6
litre collection chamber
•Easy to read Hi/Low volume
graduations (write on)
•Integrated floor stand
•Strand hanger
•Clear PVC connection tubes
with anti kink device
THORA SEAL III
• Analogy of the 3 bottle
concept
• Compact, break resistant
•Removable/Replacable
collection chamber with:
- Hi/Low volume graduations
- White, write-on background
• Unique baffle system prevents
fluids from spilling and mixing
THORA SEAL III
•Automatic possitive pressure
relief valve
•Build-in hanger, floor stand
and tube anti-kink device
•Muffler in suction control
•Self-sealing Kraton patient
tube
Aqua Seal
• 3 bottle system concept
• Compact, break resistant
• Easy to install and use
• Collection chamber:
- Paediatric and adult graduations
- White, write on background
- Kraton self-sealing patient tube
- Croppable connector
Aqua Seal
• Underwater Seal Chamber:
- blue coloured water level
- Patient assessment graduations
- Syrringe for easy filling in
- Automatic possitive pressure
releif valve
- Manual negative pressure relief
valve
- Water seal access port
Aqua Seal
• Suction control chamber:
- flow control valve on suction
port
- Suction control bypass adapter
- Wide opening for easy filling in
• Other:
- Wide 90 degree rot. footstand
- Steel hangers
- Integrated handle
- Setup instructions on unit
- Double CSR warp
Aqua Seal
Aqua Seal
Sentinel Seal
•Modified four bottle concept
•Exclusive „dry“ suction control
regulator
•Quiet operation
•Exclusive patient assesment
chamber with blue coloured
water level
•Automatic possitive pressure
releif valve
•Filtered manual negative pressure
relief valve
•Easy to setup and use
•Crystal clear, compact
Double Seal
Four bottle system concept
Collection chamber
- 3 column chamber
- Hi/low graduation for paediatric
and adult use
- White, write on background
- self sealing collection tube
Underwater Seal chamber
- blue coloured water level
- patient and/or system air
leak control
Double Seal
Suction control chamber
- Bubbling suction controler
- blue coloured water level
- automatic possitive pressure
relief valve
Patient assessment chamber
- actual negative pressure
readout
- continuous monitoring of
lung reexpansion process
- possitive pressure relief
- Automatic negative pressure
relief
Patient Assessment what is the CDU telling me
Tidaling*
Bubbling**
Yes
Yes
No
No
No
Yes
Yes
No
Large pneumothorax or system
leak - lung still not re-expanded
Check for changes
Lung reexpansion (slide tidaling
can be observed). Check the
collection tube for kinking
Connection or system leak
Pinch off the catheter. If the same
check all connections.
Stiff lung desease or patient after
pneumonectomy
Thoracic catheters
For open chest application (peroperative)
•Made from thermosensitive PVC or clear silicone
•Sentinel Line and Eye for X-ray possition verification
•Smooth finish on tip and eyes
•Integral bubble connector for easy connection
•Rigid pack container
Trocar catheters
For closed chest drainage
Thoracic catheter intimately seated on aluminium
trocar rod
Trocar caries the catheter with it as it penetrates
the chest wall and enters pleural cavity
Colour coded trocars for easy indentifiaction
Safety Shield Trocar catheters
Argyle
....a safety trocar thoracic catheter which:
• Minimizes the risk of inadverent lung puncture
• Provides safe, quick access to the pleural space
Thoracentesis
Exclusive Turkel Safety thoracic punture system
Minimal risk of lung punture and pneuomothorax
Safety canula - withdraws into the shaft during chest
wall penetration
Automaticaly extends when entering pleural space
Safety color change indicator confirmes the position
Thoracentesis
Pateneted safety valve allows air and fluid to leave
the chest cavity, prevents atmospheric air to enter.
Soft and flexible polyurethane radiopaque catheter
with 1 cm graduations and multiple side holes