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