water seal drainage procedure bibliography-https://www.slideshare.net/aashishparihar/water-seal-drainage

1. WATERSEAL DRAINAGE
Presented by
Rohit Tripathi
B.Sc.3RDyear

3. DEFINATION
Water seal drainage system is a closed chest
drainage system used to allow air and fluid
to escape from the pleural space with each
exhalation and to prevent their return flow
with each inhalation.

4. 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.

5. INDICATION
 Pneumothorax
 Pleural effusion
 Hemothorax
 Chylothorax
 Empyema
 Hydrothorax
 Postoperative:
E.g, thoracotomy, oesophagectomy, cardiac surgery

6. CONTRAINDICATION
Coagulopathy
Diaphragmatic hernia
Hepatic hydrothorax
Pregnancy only pleural tapping/thoracentesis is
indicated

7. 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.

8. Site for chest tube insertion
1. Thoracic surgery
Chest tube are inserted:
 Anterior chest tube
 Posterior chest tube

9. Anterior chest
tube
 Upper/anterior chest wall
 Inserted in the 2nd or 3rd intercostal space to
remove the AIR(pneumothorax) arising from the
pleural cavity.
 Size of chest tube will be used to drain air 16-20 Fr.

10. Posterior chest tube
 Placed at the posterior chest in the 8th or 9th
intercostal space at the mid axillary line.
 Indication to remove FLUID(eg; hemothorax,
pleural effusion) at the lower area of pleural cavity.
 Diameter of tube in the lower section is wider or
longer compare to the upper tube.
 Size of chest tube will be used to drain blood/pus
20-36 Fr.

12. CHEST DRAINAGE
SYSTEM
chest drainage system
1 bottle 2 bottle 3 bottle Pleurovac

13. 1 bottle 2 bottle
3 bottle

15. FUNCTION OF PLEURAL DRAINAGE
SYSTEM
INSPIRATIO
N
INTRA
PLEURAL
PRESSURE
AIRAND
FLUID
MOVE
INTO
BOTTLE
PLEURAL
SPACE
BECOME
NEGA
TIVE
LUNGS
REEXP
AND

16. Chest tube insertion

17. PRINCIPLES OF THE CHEST TUBE
A. Gravity
B. Under water seal
C. Suction

18. A. GRAVITY
 Enhances flow from high to
low.
Chest drain is placed below
client’s bed.

19. B. 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.

20. C. SUCTION
Is a pull force.
Must be in another bottle.
Purpose for the suction is, 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.

21. COMPLICATION
Injury to :
Lungs
 Heart
 Liver
Other organ and soft tissue

22. FACTORS AFFECTING WATER
SEAL DRAINAGE
1. Proper placement of the 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

23. 1. Proper placement of chest catheter
2nd and 3rd intercostal space and 8th and 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.

24. 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.

25. 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.

26. 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.

27. 5.Maintenance of air tight drainage
system
Drainage system should be air tight with stoppers
and all the tubing should be taped well.

28. 6. Position of the client
Fowler’s position.
So that fluid can be localized in lower pleural space
and can be drained out easily.

29. 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.

30. 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.

31. Nursing Responsibilities
Criteria for good functioning of water seal
drainage apparatus.
Nursing care of the patient with water seal
drainage.

32. 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 malfunction of suction are:
 Air leaking into the pleural space.
 Air leaking into the drainage apparatus.
 Mechanical problem to the pump.

33. Nursing care of the patient with water
seal drainage
 As a nurse we should have proper knowledge of purpose,
principles, equipment used and early sign and symptoms of
complication of water seal drainage.
 Instruct the client and by standards how to clamp the
drainage in emergency situation and how to handle the water
seal drainage.
 Sutured site should be well padded and secured with
adhesive tapes.
 Clamp or hemostat clamp should be readily available near to
the patient.

34. Conti…
• 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.
•Do not use pins to secure the tubing with bed.
•Check the patency of chest tubing regularly.

35. Conti…
•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.

36. Conti…
•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 bottles 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.

37. Conti…
•
•
•
•
Criteria for removal of water seal drainage is as follows:
1. Absence of air leak.
2. Drained fluid is less than 75ml/day
3. Chest x-ray should reveal the re-expansion of lungs well.
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.

38. SUMMARY
Water seal drainage system is a closed chest
drainage system used to allow air and fluid to
escape from the pleural space with each exhalation
and to prevent their return flow with each inhalation
in the case of pneumothorax, pleural effusion,
empyema etc.

39. CONCLUSION
Water seal drainage system is used to treat many
pulmonary conditions. Pneumothorax is a life
threatening even that can be quickly treated. Proper
technique will minimize complications. Careful
management of chest tube will expedite their removal
and improve patient status.

40. BIBLIOGRAPHY
• Slideshare.net/aashishparihar/water_seal_drainage.
• Ncbi.nlm.nih.gov/pmc/articles/PMC4356865/
• Kau.edu-
sa/files/0012869/subjects/underwaterseal%20bridgi
ng-sohad2014.pdf
• En.Wikipedia.org/wiki/chest_tube