Ann Thorac Surg 2006;81:2335-2336
© 2006 The Society of Thoracic Surgeons
Correspondence
Chest Bottle "Foam" Problem Caused by Persistent Air Leak: An Alternative Solution
Jia-Ming Chang, MD,
Yau-Lin Tseng, MD,
Ming-Ho Wu, MD,
Wu-Wei Lai, MD,
Mu-Yen Lin, MD,
I.-Lin Shu, MD
Department of Surgery, Thoracic Division and Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, No 138 Sheng-Li Rd, Tainan, 704 Taiwan, ROC
(Email: jameschang127{at}hotmail.com).
To the Editor:
After reading the article by Cesario and colleagues [1] concerning the application of simethicone (activated polydimethylsiloxane) to solve the foam problem in sealed water-valve bottles in cases of persistent air leak after pulmonary resection, we would like to share our experience in managing this specific issue.
In our institute we choose a totally different agent (ie, 5 to 10 mL of 95% ethanol) to eradicate the foam problem. As it is generally known, bubbles in the underwater-sealed bottles are formed because of stirring caused by a continuous air leak from chest tube drainage along with decreased surface tension created by protein components in pleural drainage. Then the three-dimensional structures of proteins unfold. Specific properties are lost if certain physical environmental conditions are manipulated, such as a rise in temperature, extreme changes in acidic or alkaline pH, or the application of solvents of certain organic molecules such as ethanol in a process called denaturation [2].
Using our technique we add 95% ethanol into the underwater-sealed bottle, and all the bubbles in the bottle disappear after lightly stirring. The major advantage with this method is that the effect on the elimination process of the foam in the bottles is not long-lasting once the ethanol evaporates. Therefore, subsequent re-evaluation of the air leak and drainage amount are not compromised. In addition, ethanol is quite obtainable in most medical facilities and is rather economical. This method causes no harm to the patient because there is no direct contact with the ethanol by the patients through the chest tube to the drainage system, with or without the application of suction apparatus. Therefore we recommend ethanol application as an alternative solution to the foam problem in the water-valve bottles with continuous air leak.
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References
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- Cesario A, Galetta D, Margaritora S, Kawamukai K, Porziella V, Granone P. Persistent air leak after pulmonary resectionthe water-valve "foam" problem. Ann Thorac Surg 2004;78:389-390.[Free Full Text]
- The three dimensional structures of proteins. In: Mathews CK, van Holde KE, Ahern KG. Biochemistry, 3rd ed. Corvallis, OR: Benjamin Cummings; 1999:181..
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