WATER SEAL DRAINAGE

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 water seal drainage
DEFINITION
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.
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
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
Site for chest tube insertion
1. Thoracic surgery.
2. chest tube are inserted – Anterior chest tube Posterior chest tube
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.
Site for chest tube insertion
2. Pneumothorax:
 Tube placed at the 2nd or 3rd Intercostal space along mid- clavicle or anterior Axillary
line.
Chest Drainage System
 1 bottle
 2 bottles
 3 bottles Pleurovac

FUNCTION OF PLEURAL DRAINAGE SYSTEM

Inspiration Intrapleural pressure Air and fluid move into bottle Pleural space becomes negative
Lungs reexpand
PRINCIPLES OF THE CHEST TUBE
1. Gravity
2. under water seal
3. Suction
1. PRINCIPLES OF THE CHEST TUBE -Gravity Enhances flow from high to low Chest
drain is placed below client’s bed
2. PRINCIPLES OF THE CHEST TUBE - Under Water Seal
 Is a barrier to prevent 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
3. PRINCIPLES OF THE CHEST TUBE - 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
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
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
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
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
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.
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
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
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
Nursing Responsibilities
• Criteria for good functioning of water seal drainage apparatus Nursing care of the
patient with water seal drainage.
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)
• 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.
Nursing care of the patient with water seal drainage
 • As a nurse we should have proper knowledge of purpose, principles, equipment’s 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.
• 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
• 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
• 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.
• Assess the proper functioning of the water seal drainage

While replacing the chest drainage bottle follow these instructions

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.
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.
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.
4. Prior to removal of the water seal drainage system chest tubing should be clamped at
least for two hours.
5. After removal, wound should be covered with sterile petroleum gauze and firm
dressing secured with wide strip of adhesive tapes.
6. Observe the patient for any respiratory distress post removal the water seal drainage
system.