1. watersealdrainage
 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

2. watersealdrainage

3. 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
watersealdrainage

4. watersealdrainage
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.

5. 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
watersealdrainage

6. watersealdrainage
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

7. watersealdrainage
Site for chest tube insertion
1. Thoracic surgery.
2 chest tube are inserted –
Anterior chest tube
Posterior chest tube

8. watersealdrainage
Site for chest tube insertion
Anterior chest :
 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.

9. watersealdrainage
Site for chest tube insertion
2.Pneumothorax :
 Tube placed at the 2nd
or 3rd Intercostal
space along mid-
clavicle or anterior
Axillary line.

10. watersealdrainage
Chest Drainage
System
1 bottle 2 bottles 3 bottles Pleurovac

11. watersealdrainage
TYPES OF SYSTEM - 1 BOTTLE
DRAINAGE

12. TYPES OF SYSTEM - 2 BOTTLE
DRAINAGE
watersealdrainage

13. TYPES OF SYSTEM - 3 BOTTLE
DRAINAGE
watersealdrainage

14. FUNCTION OF PLEURAL DRAINAGE
SYSTEM
watersealdrainage
Inspiration
Intrapleural pressure
Air and fluid move
into bottle
Pleural space
becomes negative
Lungs reexpand

15. watersealdrainage
PRINCIPLES OF THE CHEST TUBE
1. Gravity
2. Under water seal
3. Suction

16. watersealdrainage
PRINCIPLES OF THE CHEST
TUBE
1. Gravity
Enhances flow from
high to low
Chest drain is placed
below client’s bed

17. watersealdrainage
PRINCIPLES OF THE CHEST TUBE
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

18. watersealdrainage
PRINCIPLES 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 weak
iii. - air leak is fast into the pleural space
iv. - need to speed up removal from pleural space

19. watersealdrainage
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

20. watersealdrainage
Factors affecting water seal drainage
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

21. watersealdrainage
Factors affecting water seal drainage
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

22. watersealdrainage
Factors affecting water seal drainage
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

23. watersealdrainage
Factors affecting water seal drainage
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.

24. watersealdrainage
Factors affecting water seal drainage
5. Maintenance of air tight drainage system
 Drainage system should be air tight with
stoppers and all the tubing should be taped well

25. watersealdrainage
Factors affecting water seal drainage
6. Position of the client
 Fowler’s position
 So that fluid can be localized in lower pleural
space and can be drained out easily

26. watersealdrainage
Factors affecting water seal drainage
7. 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 weak
iii. - air leak is fast into the pleural space
iv. - need to speed up removal from pleural space

27. watersealdrainage
Factors affecting water seal drainage
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

28. watersealdrainage
Nursing Responsibilities
 Criteria for good functioning of water seal drainage apparatus
 Nursing care of the patient with water seal drainage.

29. watersealdrainage
Nursing Responsibilities
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) contd…

30. watersealdrainage
contd…
Proper functioning of suction
Reason for mal function of suction are-
Air leaking into the pleural space
Air leaking into the drainage apparatus
Mechanical problem to the pump

31. watersealdrainage
Nursing Responsibilities
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
contd..

32. watersealdrainage
Nursing Responsibilities
Nursing care of the patient with water seal
drainage
contd..
 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..

33. watersealdrainage
Nursing Responsibilities
Nursing care of the patient with water seal drainage
contd..
 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..

34. watersealdrainage
Nursing Responsibilities
Nursing care of the patient with water seal drainage
contd..
 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..

35. watersealdrainage
Nursing Responsibilities
Nursing care of the patient with water seal drainage
contd..
 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..

36. watersealdrainage
Nursing Responsibilities
Nursing care of the patient with water seal drainage
contd..
 Assess the proper functioning of the water seal
drainage
 While replacing the chest drainage bottle
follow these instructions….
contd..

37. watersealdrainage
Nursing Responsibilities
Nursing care of the patient with water seal drainage
contd..
1. 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. contd..

38. watersealdrainage
Nursing Responsibilities
Nursing care of the patient with water seal drainage
contd..
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.

39. watersealdrainage
Nursing Responsibilities
Nursing care of the patient with water seal drainage
contd..
 Criteria for removal of water seal drainage is as
follows:
1. 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..

40. watersealdrainage
Nursing Responsibilities
Nursing care of the patient with water seal drainage
contd..
 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