medical surgical nursing

1. WATERSEAL
DRAINAGE
Mr. Melvin Jacob
MSc Nursing
1Mr. 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.
2Mr. 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 3Mr. 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
4Mr. 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.
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6. Site for chest tube insertion
2.Pneumothorax :
Tube placed at the 2nd or 3rd Intercostal
space along mid- clavicle or anterior Axillary
line.
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7. Types of drainage System
• 1 bottle drainage system
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8. .
• 2 bottles drainage system
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9. .• 3 bottles drainage system
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10. Principles of the chest tube
1. Gravity
Enhances flow from high to low Chest
drain is placed below client’s bed
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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
11Mr. Melvin Jacob

12. .
3. Suction
• Is a pull force
• MUST be in another bottle
Purpose for the suction is, when :
o gravity drainage is not enough.
o patient’s respiration and cough are too weak
o air leak is fast into the pleural space iv. - need to
speed up removal from pleural space
12Mr. 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
13Mr. 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
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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
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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
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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.
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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
18Mr. Melvin Jacob

19. 7. Application of mechanical suction
• Continuous and gentle suction is used when :
Gravity drainage is not enough.
Patient’s respiration and cough are too weak
Air leak is fast into the pleural space
Need to speed up removal from pleural space
19Mr. 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
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21. Nursing Responsibilities
• Criteria for good functioning of water seal
drainage apparatus
• Nursing care of the patient with water seal
drainage.
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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
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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.
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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
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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
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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
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27. Instructions for replacing
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
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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.
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29. Criteria for removal
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..
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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
30Mr. Melvin Jacob

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

32. THANK
YOU
32Mr. Melvin Jacob