Q The Atrium dry suction chest drainage system can be set to −40 cm H2O. The water-filled suction chambers I have used only go to −20 cm H2O; I have never seen suction pressures other than −20 cm H2O ordered. What circumstances warrant a chest drain suction pressure greater than −20 cm H2O?

A Patricia Carroll RN,BC, CEN, ARRT, MS, replies

First, it is important to understand how the current state of the art developed with regard to suction pressures used with chest tubes. There are no data to guide an evidence-based decision on the suction limit established with a chest drain system.1 Chest drainage was originally established by using a 1-, 2-, or 3-bottle system. In one of these glass bottles, a straw submerged under 2 cm of water established a water seal. In some cases, suction was generated by...

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