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
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