water seal drainage Definition Indication Purposes Site for chest tube insertion Type of water seal drainage
system FUNCTION OF PLEURAL DRAINAGE
SYSTEM PRINCIPLES OF THE CHEST TUBE Nursing Responsibilities
water seal drainage
Definition
Water seal drainage system is a closed chest drainage system used to allow air and fluid to escape from the plural space with each exhalation and to prevent their return flow with each inhalation
water seal drainage
water seal drainage
Water seal means that the water in the bottle seals off the atmospheric air thus prevents the entering of air or fluid back into the pleural space.
Indication1. Traumatic pneumothorax2. Hemopneumothorax3. Spontaneous pneumothorax4. Iatrogenic pneumothorax5. Broncho-pleural fistula6. Emphysema7. Malignancy8. Pleural effusion9. Thoracic or thoraco-abdominal surgeries
water seal drainage
water seal drainagePurposes
To permit drainage of air and fluid from the pleural cavity
To establish normal negative pressure in the pleural cavity for lung expansion
To equalize pressure on both sides of the thoracic cavity
To provide continuous suction to prevent tension pneumothorax
water seal drainage
Site for chest tube insertion1. Thoracic surgery. 2 chest tube are inserted –
Anterior chest tube Posterior chest tube
water seal drainageSite for chest tube insertion
Anterior chest : Upper/anterior chest wall Inserted in the 2nd Intercostal space to remove the air
arising from the pleural cavityPosterior chest tube : Placed at the posterior chest in the 8th or 9th Intercostal
space at the mid-Axillary line. Indication to remove sero-sangeneous fluid at the lower
area of pleural cavity Diameter of tube in the lower section is wider or longer
compare to the upper tube.
water seal drainage
Site for chest tube insertion
2. Pneumothorax : Tube placed at the 2nd
or 3rd Intercostal space along mid-clavicle or anterior Axillary line.
water seal drainage
Chest Drainage System
1 bottle
2 bottle
s
3 bottle
sPleuro
vac
water seal drainageTYPES OF SYSTEM - 1 BOTTLE DRAINAGE
TYPES OF SYSTEM - 2 BOTTLE DRAINAGE
water seal drainage
TYPES OF SYSTEM - 3 BOTTLE DRAINAGE
water seal drainage
FUNCTION OF PLEURAL DRAINAGE SYSTEM
water seal drainage
Inspiration
Intrapleural pressure
Air and fluid move into bottle
Pleural space becomes negative
Lungs reexpand
water seal drainage
PRINCIPLES OF THE CHEST TUBE1. Gravity
2. Under water seal
3. Suction
water seal drainage
PRINCIPLES OF THE CHEST TUBE
1. Gravity
Enhances flow from high to low
Chest drain is placed below client’s bed
water seal drainage
PRINCIPLES OF THE CHEST TUBE2. Under Water Seal
Is a barrier to prevents backflow into pleural space.
Rod – depth determines the negative pressure Air bubbles is released through the rod Air vent – to allow drained air to escape to
prevent pressure build up
water seal drainagePRINCIPLES OF THE CHEST TUBE
3. Suction Is a pull force MUST be in another bottle
Purpose for the suction is, when :i. - gravity drainage is not enough.ii. - patient’s respiration and cough are too weakiii. - air leak is fast into the pleural spaceiv. - need to speed up removal from pleural space
water seal drainage
Factors affecting water seal drainage1. Proper placement of chest catheter2. Proper placement of chest drainage apparatus3. Length of drainage tubing4. Patency of chest tubing5. Maintenance of air tight drainage system6. Position of the client7. Application of mechanical suction8. Activity of the client
water seal drainage
Factors affecting water seal drainage1. Proper placement of chest catheter
• 2 & 3rd intercostal space and 8 &9th intercostal space
• These catheter should be connected to the separate bottle
• When there is single tube it is usually placed in lower intercostal space
water seal drainage
Factors affecting water seal drainage2. Proper placement of drainage apparatus Drainage apparatus should be placed at lower
level then the chest It helps in gravity and also prevent the back
flow of air and fluid into pleural cavity While transferring patient apparatus should be
placed over the bed or trolley after clamping the tubing at two places
water seal drainage
Factors affecting water seal drainage3. Length of drainage tubing
Drainage tubing neither too short nor too long It should fall in straight line to the drainage
system There should not be any loop of drainage tubing Too short drainage tubing may restrict the
movement of patient on bed or it may get disconnected from the catheter
water seal drainage
Factors affecting water seal drainage4. Patency of chest tubing
Patency of chest tube should be checked frequently Any kink or pressure over chest tubing may obstruct
the flow from pleural space Ensure that patient is not lying over the tubing Any clot or mucus plug in pleural space may also
obstruct the flow Milking the tube helps to dislodge the plug Never clamp the tubing until it is necessary.
water seal drainage
Factors affecting water seal drainage5. Maintenance of air tight drainage system
Drainage system should be air tight with stoppers and all the tubing should be taped well
water seal drainage
Factors affecting water seal drainage6. Position of the client
Fowler’s position So that fluid can be localized in lower pleural
space and can be drained out easily
water seal drainage
Factors affecting water seal drainage7. Application of mechanical suction
Continuous and gentle suction is used when :i. - gravity drainage is not enough.ii. - patient’s respiration and cough are too weakiii. - air leak is fast into the pleural spaceiv. - need to speed up removal from pleural space
water seal drainage
Factors affecting water seal drainage8. Activity of the client
Movement of the patient on bed helps the fluid to drain from chest.
Patient should be encouraged to cough and deep breath
Which helps in rising the intra-pleural and intra-pulmonary pressure
water seal drainage
Nursing Responsibilities
Criteria for good functioning of water seal drainage apparatus
Nursing care of the patient with water seal drainage.
water seal drainage
Nursing ResponsibilitiesCriteria for good functioning of water seal
drainage apparatus Observe for the fluctuating movement
of fluid inside the tubing Observe the chest drainage Watch for bubbling in water seal bottle
(intermittent bubbling is normal) contd…
water seal drainage
contd…Proper functioning of suctionReason for mal function of suction are-Air leaking into the pleural spaceAir leaking into the drainage apparatusMechanical problem to the pump
water seal drainage
Nursing ResponsibilitiesNursing care of the patient with water seal drainage
As a nurse we should have proper knowledge of purpose, principles, equipments used and early sign and symptoms of complication of water seal drainage.
Instruct the client and bystanders how to clamp the drainage in emergency situation and how to handle the water seal drainagecontd..
water seal drainage
Nursing ResponsibilitiesNursing care of the patient
with water seal drainagecontd.. Affix a sign board “do not
handle” Sutured site should be well
padded and secured with adhesive tapes
Clamp or hemostat clamp should be readily available near to the patient. contd..
water seal drainage
Nursing ResponsibilitiesNursing care of the patient with water seal
drainagecontd.. Never clamp the chest tubing until it is necessary or
ordered by the physician Apparatus of chest drainage should be kept lower than
the chest level of the patient During transportation clamp the tubing and keep the
apparatus top of the bed. contd..
water seal drainage
Nursing ResponsibilitiesNursing care of the patient with water seal
drainagecontd.. Make sure that position of the client should not exert
pressure over the chest tubing. Chest tubing neither too short nor too long Do not use pins to secure the tubing with bed Check the patency of chest tubing regularly
contd..
water seal drainage
Nursing ResponsibilitiesNursing care of the patient with water seal
drainagecontd.. Ensure the air tightening of the chest drainage Follow the strict aseptic technique Encourage the deep breathing and coughing exercises Ensure that tubes are immersed in water well to
create water seal drainage contd..
water seal drainage
Nursing ResponsibilitiesNursing care of the patient with
water seal drainagecontd.. Assess the proper functioning of the water seal
drainage While replacing the chest drainage bottle
follow these instructions…. contd..
water seal drainage
Nursing ResponsibilitiesNursing care of the patient with water seal
drainagecontd..1. Assemble the bottle with tube and stopper and check
their functioning2. Clamp the chest tube near to the chest prior to
disconnecting it3. Disconnect the bottle and connect the new bottle but
remember that chest tubing should not be contaminated. contd..
water seal drainage
Nursing ResponsibilitiesNursing care of the patient with water seal
drainagecontd..4. Be certain that bottle/s are kept well below the chest
level 5. Unclamp the chest tubing and check the functioning
of the system6. Observe the patient for any complication before
leaving.
water seal drainage
Nursing ResponsibilitiesNursing care of the patient with water seal
drainagecontd.. Criteria for removal of water seal drainage
is as follows:1. Absence of air leak2. Drained fluid is less than 75 ml/day3. Chest X-ray should reveal the re-
expansion of lungs well contd..
water seal drainage
Nursing ResponsibilitiesNursing care of the patient with water seal
drainagecontd.. Prior to removal of the water seal drainage system chest
tubing should be clamped at least for two hours. After removal, wound should be covered with sterile
petroleum gauze and firm dressing secured with wide strip of adhesive tapes
Observe the patient for any respiratory distress post removal the water seal drainage system
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