1. 1.Bubbling –There are two types of bubbling
   

1. a.Bubbling through the underwater seal valve (or through the air leak indicator) indicates a persistent air leak. The presence of a leak should be recorded on the daily record chart. The drain will not be removed for 48 hours after last bubble.
   

2. b.Bubbling through the suction control chambers indicates that adequate suction is being applied. If there is NO bubbling, there is no suction and the drainage system is acting as a partial clamp. If suction has been prescribed, the situation should be corrected urgently. This usually means checking the suction attachments and turning it up till bubbles appear with each breath. The fine adjustment lever may also need to be adjusted.
   

3. 3.Height of water in suction control - evaporation due to excessive bubbling can reduce the water level and therefore the level of suction. The water level should be checked regularly and kept filled to the 20cm mark (or less in children).
   

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4. 4.Swinging
   

5. •a rise and fall of the fluid level in the tubing occurs with each breathe.
   

6. •The presence of a swing mainly tells you the tube is in the pleural cavity, and it is not blocked
   

7. •A drain on suction will have reduced or no swing.
   

8. •All drains eventually block with fibrin/clot. At that stage they should be removed.
   

9. •A drain which has just been inserted, is in the pleura but does not swing may be buried in clot. Usually there will be a lot of clotted blood in the tubing. Further drains or thoracotomy may be required.
   

10. •The presence of a large swing means the underlying lung is under a lot of tension. In this situation there is the risk of indrawing of air during removal. Removal should be postponed for a number of days.
    

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5. 5.Wound – infection. Leakage around drain
   

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6. 6.Daily drainage  - draw line on label on bottle and put time and date. Do NOT tip fluid over into collection chamber on a daily basis. Do NOT change drain daily.
   

Measuring

1. •Daily drainage  - draw line on label on bottle and put time and date. Do NOT tip fluid over into collection chamber on a daily basis. Do NOT change drain daily.
   

2. •Record in chart the daily drainage
   

When to remove

1. •In the presence of an air leak the drain should not be removed unless another drain remains
   

2. •In general a period of 48 hours after the last bubble is safe.
   

3. •In the presence of fluid, remember that 100-200cc normally drain from a pleural drain. Otherwise once the drainage is less than 150cc it may come out.
   

4. •Exceptions include the presence of pus (empyema), lymph (chylothorax) or a residual cavity