1. This system consists of the waterproof bottle, the liquid collection bottle and a third bottle controlling the amount of suction applied. Chest drainage, also called chest tubes, underwater sealed drainage (UWSD), thoracic catheters, tubular thoracic acostalstomy or intercostal drainage. Chest drains provide a method to remove air and fluids from the pleural space. The idea is to create a disposable mechanism that lets air/fluid out of the pleural space and prevents outside air/fluid from entering the pleural space. This is achieved using an underwater seal. The distal end of the drainage pipe is immersed in 2 cm of H2O. They use flexible plastic tubes that are inserted through the chest wall and into the pleural space between the 5th and 6th intercostal space in the line of the central axis, evacuating the space, allowing air to come out again. [1] Collect drainage samples for cultivation via the unnecessary sampling port on the in-line connector.
(2) The third cylinder, called a pressure gauge bottle, has three tubes. A short tube above the water level comes from the waterproof bottle. A second short pipe leads to suction. The third pipe extends below the water level and opens onto the atmosphere outside the bottle. It is this pipe that regulates the extraction according to the depth at which the pipe is immersed. It is usually submerged by 20 cm (7.6 inches). If the pleural pressure is positive, the pressure in the rigid straw becomes positive, and if the overpressure in the rigid straw is greater than the depth at which the pipe is immersed in the saline solution, then the air enters the bottle and is then depressurized by ventilation in the atmosphere. If the pleural pressure is negative, it moves the liquid from the bottle into the rigid straw and the air does not enter the pleural cavity or rigid straw. This system is called waterproofing because the water bottle seals the pleural cavity with air or liquid from outside the body. Just like a straw in a drink, air can grow through the straw, but air cannot be brought back into the straw.
The objectives of an adequate chest drainage system are: (I) to remove fluid and air as soon as possible; (II) Prevent drained air and fluid from returning to the pleural space, restore negative pressure in the pleural space to dilate the lungs again. Therefore, a drainage device must: (I) leave air and liquid from the chest; (II) contain a unidirectional valve to prevent air and fluid from returning to the chest; (III) be so designed that the device is below the level of the chest tube for gravity drainage. An underwater chest drainage system is used to restore proper air pressure in the lungs, reinflate a collapsed lung, and remove blood and other fluids. The system is a two- or three-chamber plastic unit with vertical columns that provide measurements in milliliters. Chest drainage devices cover a wide spectrum and have evolved considerably since their introduction. The basic design principle of these systems was to avoid the entry of air into the pleural cavity during the different phases of the respiratory cycle and the continuous drainage of air and fluid from the pleural cavity. A key issue for the successful treatment of patients is to understand how these systems work. The application and development were based on the original one-bottle system. Understanding this system of principle introduces us to the mechanism of function. Clinicians can assess air leakage scientifically and objectively, as the data can be examined graphically.
Drain removal is performed when flow is minimal and graphs are stable. In one randomised trial, it was reported that using such an electronic chest drainage device was associated with a saving of around €500 per patient (20). On the other hand, it has been shown that the use of the breast probe is two days shorter and that a shorter hospital stay of 1.5 days was achieved with a resulting saving of about €750 per patient (21). An ideal digital chest drainage system has the following features: large, user-friendly tank for fluid collection and analysis; functional in different stages of suction; compact to allow outpatient treatment of the patient; latex-free, silent, tipped, reusable and inexpensive; continuous and accurate digital measurement of the amount of drainage from the chest tube and the size of air leaks; written recording of events in the pleural space; easy to use for staff and patients; allows the patient to be sent home on the same device; Data made available to the nurses` department or the doctor`s office for evaluation (22-39). There is no doubt that the future belongs to new technologies. However, the introduction of digital devices depends on many parameters: the superiority of quality, the familiarity of medical and nursing staff, education and training, the culture of the introduction of technological progress, the availability of sources and profitability are among them (40-59). For specialists, the most effective device is usually the best known, but air leaks remain a medical challenge and sometimes require a sophisticated approach and flexibility to provide a reliable solution, ensure quality of life, not cause pain or discomfort, and at the same time reduce costs (50,60-66). A system that allows drainage of the pleural space with an airtight system to maintain subatmospheric intrameral pressure; The underwater seal acts as a one-way valve The next step in the development of chest drainage units was the development of dry suction control chambers. Dry suction control systems offer many advantages: higher suction pressure values can be achieved, the configuration is simple, and there is no need to evaporate the liquid, which would reduce the suction power applied to the patient. (4) When the suction is added, it shall be connected to the ventilation hose in the watertight cylinder. Three situations can cause high negative pressure: (I) the patient with shortness of breath, severe cough or crying; II) stripping of the chest tube; (III) reduction or separation of aspiration. Vigorous milking or stripping can create dangerously high negative pressures.
Research has documented negative pressures up to -450 cm H2O. The system prevents the accumulation of excessive high negative pressure, as indicated above; However, the transient high negative pressure produced by vigorous can put the patient at risk of mediastinal trauma and transplant trauma. We must handle with caution and follow established hospital protocols. As already mentioned, there is a manual pressure relief valve with high negativity on chest drainage systems. Pressing the pressure relief valve with high negativity allows filtered air to enter the system, reducing negativity and bringing the water level in the waterproofer back to the initial value. We must use the pressure relief valve with high negativity with caution. If suction is not effective or gravity drainage is actuated, removing the pressure relief valve with high negativity can reduce the negative pressure inside the collection chamber to zero (atmosphere), resulting in pneumothorax (7). In 1967, Deknatel introduced the first integrated disposable chest drainage based on the three-bottle system. The main reason for this approach at the time was that this suction was still necessary to suck air and fluid from the pleural space and pull the lungs against the parietal pleura.
If suction is required, a third bottle is added. However, recent research has shown that suction can actually prolong air leakage from the lungs by pulling air through the opening, which would otherwise close on its own (2,3). One of the rooms in the unit is the collection chamber. The patient tube connects the drainage unit directly to the breast tube. Any drainage from the chest flows into this chamber. The collection chamber must be calibrated and has a writing surface to allow easy measurement and recording of the time, date and amount of drainage. The central chamber of a traditional chest drainage system is waterproofing. The main purpose of waterproofing is to allow air to escape from the pleural space during exhalation and to prevent air from entering the pleural cavity or mediastinum when inhaled. If the sealing chamber is filled with sterile liquid up to the 2 cm line, a 2 cm waterproofing is produced. To maintain an effective seal, it is important to maintain the chest drainage unit at all times and monitor the water level in the waterproofer for evaporation.
Sometimes it is necessary to exert negative pressure in the pleural cavity to facilitate the re-expansion of the underlying pulmonary parenchyma or to accelerate the removal of air from the pleural cavity. The addition of a third bottle allows the controlled application of suction. A vent in the suction control bottle is connected to a vent on the water cap bottle. The two bottles are connected to each other. The suction bottle has a rigid straw similar to that of the water cap bottle. The negative pressure inside the suction system corresponds to the depth of immersion of the rigid straw under the liquid surface of the bottle.
