• The following laboratory tests should be done
on the fluid obtained from the effusion:
• Protein levels.
• Lactic acid dehydrogenase levels.
• Glucose levels.
• Blood cell count and differential.
• pH levels.
• Gram stain.
• Aerobic and anaerobic culture.
• Other cultures as indicated (eg, viral, mycoplasma, fungal).
• Monitoring the drainage system after insertion of the chest tube
allows you to assess function and determine appropriate timing of
• In the standard Pleurevac system, there is colored fluid that
demonstrates both the amount of suction being applied and allows
assessment for air leaks.
• If air bubbles are seen in this chamber, there is an air leak
in the system. Although this could be from a bronchopleural fistula,
it can also be due to a side port being outside the chest wall or
air entering the system through insecurely attached tubing.
• The patency of the chest tube can be assessed by fluctuation
of the colored fluid with inspiration and expiration by the patient.
• If the fluid does not fluctuate, then there may be a kink
in the tubing or a clot in the tubing.
• The other side of the drainage device will collect the draining
• The appearance and amount of the fluid should be assessed routinely.
• Most often, placing a mark on the outside of the container with
a date and time helps determine the amount of fluid that is draining.
• Normal pleural fluid production in an adult is about 10–15
mL/d. Normal values for children are not available, but
expectations proportionately extrapolated from adult values are
• Knowing the normal values allows assessment of when the fluid
has slowed down in drainage and removal of the tube can be considered.
• An intermediary step is to place the patient to water seal (no
suction being applied) and monitor for drainage.
• If there continues to be no drainage, then the tube can be clamped
off (no drainage allowed even to gravity).
• Chest radiograph evaluation after each of these steps allows
for determination of reaccumulated fluid.
• If fluid reaccumulates at any point, continue suction drainage.
• If no accumulation occurs, then the tube may be removed.
• To remove the tube, undo the dressing and remove the suture.
• Use petroleum-impregnated gauze and hold over tube insertion
• While the patient performs a Valsalva maneuver, quickly withdraw
the tube and cover insertion site with gauze.
• Cover petroleum gauze with bandage.