Underwater seal drainage, Schemes and Mind Maps of Nursing

Download Underwater seal drainage and more Schemes and Mind Maps Nursing in PDF only on Docsity!

Prepared by : Mrs. Sohad Noorsaeed, RN,MSN

Outlines:

 Definition.  Indications  Site of chest tube insertion.  Insertion technique and equipment.  Nursing role and responsibilities.  Chest drainage management.  Complications and contraindications.  Criteria of chest tube removal.

Indications:

 To remove the residual air and drainage fluid from the

pleural space.

 This assists in the re expansion of remaining lung tissue.

 To restore negative pressure.

 Chest tube used during and immediately after thoracic

surgery (e.g. open heart surgery). Mediastinal.

Nursing role:

 Assess patient for pneumothorax, hemothorax or presence of respiratory distress.

 Obtain a chest X-ray.

 Assemble drainage system.

 Reassure the patient.

 Explain to patients the steps of the procedure. Tell the patient to expect a needle prick and a sensation of slight pressure during infiltration anesthesia.

 Position the patient according to physician preference.

Equipments:

 Tube thoracotomy tray.  Suture material.  Local anaesthetic.  Chest tube.  Syringes.  Needles.  Iodine  Sterile water.  Sterile scalpel and gloves.  Two large clamps.  Chest drainage system ,collection bottles

(Insertion) by Physician

 The skin is prepared and anesthetized using local anesthetic with a short 25 G needle.

 The needle catheter is inserted through the needle into the pleural space.  A small incision through the muscle in the intercostalspace is performed.

 chest tube is inserted into the pleural space and connected to a drainage system.

 The catheter is attached to a connector/tubing and attached to drainage system (underwater-seal or commercial system).  The tube is sutured in place and covered with a sterile dressing.

The Single-Bottle Water-Seal System

 (1) Connecting or drainage tubing joins the patient's chest tube with a drainage

tube that enters the drainage bottle.

 (2) The end of the glass rod is submerged in water, extending about 2-3 cm

below the water level(The higher the fluid level, the more pressure it takes to push air through the fluid as it leaves the chest).

 (3) The water seal provides a low-resistance, one-way valve that allows air to

leave the chest while preventing atmospheric air from being pulled into the chest during breathing.

 (4) Drainage depends upon gravity.

 (5) The second tube in the drainage bottle is a vent for the escape of any air

drained from the lung. The air will bubble through the water and leave the chest drain system through the atmospheric vent.

 (6) Bubbling at the end of the drainage tube may or may not be visible.

Bubbling may mean persistent air leaking from the lung or a leak in the system.

 (7) The water level in the bottle fluctuates as the patient breathes. It rises

when the patient inhales and lowers when the patient exhales. Continuous bubbling in this bottle indicates air leakage.

 (8) Since fluid drains into this bottle, be certain to mark the water level prior to

opening the system to the patient. This will allow correct measurement of patient drainage.

Both the one and two-bottle chest drainage systems rely on gravity.

However, if the patient has a large air leak into the pleural space,

gravity drainage may not be sufficient to evacuate the chest, and

suction may be required. This also means the addition of a third

bottle to the system — a suction control bottle.

The Three-Bottle Water-Seal System  (1) This system consists of the water-seal bottle, the fluid collection bottle, and a third bottle which is the suction control bottle.

 (2) The third bottle has three tubes. One short tube above the water level comes from the water-seal bottle. A second short tube leads to the suction. The third tube extends below the water level and opens to the atmosphere outside the bottle. It is this tube that regulates the suction , depending upon the depth the tube is submerged. It is normally submerged 20 cm. The key is that the depth of submersion of the tube in the suction control bottle determines the amount of suction imposed on the patient too much suction causes traumatic injury to the lungs.

 (3) The suction pressure causes outside air to be sucked into the system through the tube, creating a constant pressure. Bubbling in the suction bottle indicates the system is functioning properly.