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Tuesday, October 18, 2011

Chest Tubes/Water Seal Drainage

Chest Tubes/Water Seal Drainage

"Closed Chest Drainage"

-insertion of catheter into intrapleural space to maintain constant (-) pressure when air or fluid has accumulated

Purpose:

a. foster & permit drainage of air & serosanguinous fluid from pleural space

b. help re-expand remaining lung tissue by re-establishing normal negative pressure

c. prevent mediastinal shift & lung collapse

DRAINAGE SYSTEM

A.ONE-BOTTE SYSTEM

-serves as both collection chamber & water seal

-USE: Empyema

B.TWO-BOTTLE SYSTEM

-drainage collection

-water seal

-USE: after a thoracic surgery, pneumothorax

C.3-BOTTLE SYSTEM

-drainage collection chamber

-water seal

-suction control bottle

-USE: after a thoracic surgery, pneumothorax

D.COMMERCIAL UNITS

*PLEUR-EVAC-most popular

-lightweight & disposable

-function like 3 pay bottle

Principles Used:

GRAVITY

-fluid and air flow from higher level to lower level

-->keep below level of client's chest

WATER SEAL

-water acts as a seal; provides barrier between atmospheric air & subatmospheric intrapleural pressure

-must be AIRTIGHT

-leak can go back into the pleural space=(+) pressure

-must have AIRVENT

-provides escape route for air, prevent builds up in water seal chamber

SUCTION

-applied if air leaking in the pleural space is faster than it can be removed by water seal apparatus

-speeds up removal of air from pleural space

Nursing Care:

a.drainage should be lower than the chest

b.examine the entire system for air tightness & absence of obstruction

c.measure & document amount & character of drainage coming out; during first 24 hours-->500- 1000 ml is expected, excessive needs further evaluation

d.note for oscillation/fluctuations/ tidalling of fluid level within the water seal tube

-->means that system is patent & functioning properly

-->IF IT STOP!!>obstruction or re-expanded lungs

e.observe for INTERMITTENT BUBBLING ---normal in water seal

f. assess suction apparatus : normal=CONTINOUOS BUBBLING

g. have the ff at BEDSIDE

-rubber-shod clamps

-vaselinized gauze

-extra bottle with sterile water

h. make sure a chest XRay is requested to assess proper placement

i. maintain dry, sterile, occlusive dressing

j. WOF:respiratory distress from air or fluid accumulation

3 comments :

Unknown said...

Just to say Thank YOU.

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