Water seal drainage

medical surgical nursing

1. WATERSEAL DRAINAGE Mr. Melvin Jacob MSc Nursing 1 Mr. Melvin Jacob

2. 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. 2 Mr. Melvin Jacob

3. Indication 1 . Traumatic pneumothorax 2 . Hemopneumothorax 3 . Spontaneous pneumothorax 4 . Iatrogenic pneumothorax 5 . Broncho -pleural fistula 6 . Emphysema 7 . Malignancy 8 . Pleural effusion 9 . Thoracic or thoraco -abdominal surgeries 3 Mr. Melvin Jacob

4. Purposes 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 4 Mr. Melvin Jacob

5. Site for chest tube insertion 1. Thoracic surgery:- Two chest tube are inserted Anterior chest tube: Upper/anterior chest wall Inserted in the 2nd Intercostal space to remove the air arising from the pleural cavity Posterior 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 . 5 Mr. Melvin Jacob

6. Site for chest tube insertion 2.Pneumothorax : Tube placed at the 2nd or 3rd Intercostal space along mid- clavicle or anterior Axillary line. 6 Mr. Melvin Jacob

7. Types of drainage System 1 bottle drainage system 7 Mr. Melvin Jacob

8. . 2 bottles drainage system 8 Mr. Melvin Jacob

9. . 3 bottles drainage system 9 Mr. Melvin Jacob

10. Principles of the chest tube 1 . Gravity Enhances flow from high to low Chest drain is placed below client’s bed 10 Mr. Melvin Jacob

11. . 2. 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 11 Mr. Melvin Jacob

12. . 3 . Suction Is a pull force MUST be in another bottle Purpose for the suction is, when : gravity drainage is not enough. patient’s respiration and cough are too weak air leak is fast into the pleural space iv. - need to speed up removal from pleural space 12 Mr. Melvin Jacob

13. Factors affecting water seal drainage 1 . Proper placement of chest catheter 2 . Proper placement of chest drainage apparatus 3 . Length of drainage tubing 4 . Patency of chest tubing 5 . Maintenance of air tight drainage system 6 . Position of the client 7 . Application of mechanical suction 8 . Activity of the client 13 Mr. Melvin Jacob

14. 1. 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 14 Mr. Melvin Jacob

15. 2. 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 15 Mr. Melvin Jacob

16. 3. 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 16 Mr. Melvin Jacob

17. 4. 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. 17 Mr. Melvin Jacob

18. 5. Maintenance of air tight drainage system Drainage system should be air tight with stoppers and all the tubing should be taped well 6 . Position of the client  Fowler’s position So that fluid can be localized in lower pleural space and can be drained out easily 18 Mr. Melvin Jacob

19. 7. Application of mechanical suction   Continuous and gentle suction is used when : G ravity drainage is not enough. P atient’s respiration and cough are too weak A ir leak is fast into the pleural space N eed to speed up removal from pleural space 19 Mr. Melvin Jacob

20. 8. 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 20 Mr. Melvin Jacob

21. Nursing Responsibilities Criteria for good functioning of water seal drainage apparatus Nursing care of the patient with water seal drainage. 21 Mr. Melvin Jacob

22. Criteria 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 ) Reason for mal function of suction are- Air leaking into the pleural space Air leaking into the drainage apparatus Mechanical problem to the pump 22 Mr. Melvin Jacob

23. Nursing 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 drainage. 23 Mr. Melvin Jacob

24. . 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 . Never clamp the chest tubing until it is necessary or ordered by the physician 24 Mr. Melvin Jacob

25. . 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. Make sure that position of the client should not exert pressure over the chest tubing. Chest tubing neither too short nor too long 25 Mr. Melvin Jacob

26. . Do not use pins to secure the tubing with bed Check the patency of chest tubing regularly 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 26 Mr. Melvin Jacob

27. Instructions for replacing Assemble the bottle with tube and stopper and check their functioning 2. Clamp the chest tube near to the chest prior to disconnecting it 3. Disconnect the bottle and connect the new bottle but remember that chest tubing should not be contaminated 27 Mr. Melvin Jacob

28. . 4.Be certain that bottle/s are kept well below the chest level 5 . Unclamp the chest tubing and check the functioning of the system 6 . Observe the patient for any complication before leaving. 28 Mr. Melvin Jacob

29. Criteria for removal Absence of air leak 2 . Drained fluid is less than 75 ml/day 3 . Chest X-ray should reveal the re-expansion of lungs well contd.. 29 Mr. Melvin Jacob

30. . 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 30 Mr. Melvin Jacob

31. Reference Smeltzer – Brunner & Suddharth Textbook of Medical Surgical Nursing, Wolters kluwer publishers, 12 th edition 2009. Black – Medical Surgical Nursing, Elsevier publishers, 8 th edition 2009. Nettina – Lippincott manual of Nursing Practice, Wolters kluwer publishers, 7 th edition 2014. Lewis – Medical Surgical Nursing, Elsevier publishers, 10 th edition, 2017 11/24/2020 Melvin Jacob 31

32. THANK YOU 32 Mr. Melvin Jacob