From the Guidelines
A chest tube that is tidaling indicates that it is functioning properly and is in the correct position, with the tube holes submerged in the pleural fluid, allowing for the drainage of air or fluid from the pleural space.
Key Points
- The respiratory swing in the fluid in the chest tube is a useful indicator of tube patency and confirms the position of the tube in the pleural cavity 1.
- Tidaling refers to the fluctuation of fluid level in the chest tube with respiration, which is a normal finding in a functioning chest tube.
- The presence of bubbling in the underwater seal bottle may indicate a continued visceral pleural air leak, but it can also be seen in patients on suction when the drain is partly out of the thorax and one of the tube holes is open to the atmosphere 1.
- The management of chest tubes, including the use of suction and the removal of the tube, should be guided by clinical experience and evidence-based practices, taking into account factors such as the amount of fluid draining, the patient's temperature and general well-being, and chest radiographic and ultrasonographic appearance 2.
- High volume, low pressure suction systems are recommended for patients requiring suction, and the patient should be situated in an area where specialist nursing experience is available 3.
From the Research
Definition and Function of Chest Tubes
- Chest tubes are used to empty the pleural space of air or fluid, allowing for full lung expansion 4
- The function of chest tubes depends on adequate placement, effective drainage, and frequent re-evaluation of the patient and the chest drainage system 4
Management of Chest Tubes
- Effective drainage, suction, and water-sealing are essential components of chest tube management 5
- A water seal is considered superior to suction for most air leaks, and digital drainage devices can help standardize postoperative management 5
- The management of chest tubes must be based on careful observation, patient characteristics, and operative procedures 5
Chest Tube Drainage Systems
- Chest tubes can be connected to various drainage systems, including underwater seal, electronic systems, or vacuum bottles 6
- The classic three-bottle drainage system requires either external wall suction or gravity ("water seal") drainage 6, 7
Tidaling of Chest Tubes
- There is no direct mention of "tidaling" of chest tubes in the provided studies
- However, it can be inferred that tidaling may refer to the fluctuation of fluid or air in the chest tube, which can be affected by the patient's respiratory cycle and the drainage system used 6, 7
Complications and Removal of Chest Tubes
- Common complications of chest tubes include pain, drain blockage, and accidental dislodgment 6
- The optimal timing for tube removal is still a matter of controversy, but digital drainage systems can facilitate informed decision-making 6
- Indications for removing the drainage tube include full-expansion of the lung, no air leakage, no hemorrhage, and decrease of the pleural effusion 7