Today our topic of discussion is Managing Closed Chest Underwater Seal Drainage.
Managing Closed Chest Underwater Seal Drainage
Managing Closed Chest Underwater-Seal Drainage
- Repeatedly note the character, consistency and amount of drainage collection chamber
- Mark the drainage level in the drainage collection chamber by noting the time and date at the drainage level on the chamber every 8 hours
- Check the water level in the water-seal chamber every 8 hours, if necessary, carefully add sterile distilled water until level reaches the 2 cm mark indicated on the water- seal chamber of the commercial system
- Check for fluctuation in the water-seal chamber as the patient breathes. To check for fluctuation when a suction system is being used, momentary disconnect the suction system
- Check the water level in the suction-control chamber.
- Detach the chamber from the suction chamber when the bubbling ceases, observe the water level.
- If necessary add sterile distilled water to bring the level to the 20 cm line or as ordered
- Check for gentle bubbling in the suction control chamber because it indicates that the proper suction level has been reached
- Periodically check that the air vent in the system is working properly. Occlusion of the air vent results in a build-up of pressure in the system that could cause the patient to develop a tension pneumothorax
- Coil the systems tubing and secure it to the edge of the bed with a rubber band or tape and a safety pin.
- Avoid creating dependent loops, kinks or pressure on the tubing
- Be sure to keep two rubbers tipped clamps at the bedside to clamp the chest tube if a bottle breaks or the commercially prepared system cracks or to locate an air leak in the system
- Encourage the patient to cough frequently and breathe deeply to help drain the pleural space and expand the lungs
- Check the rate and quality of the patient’s respirations and auscultate his lungs periodically to assess air exchange in the affected lung
- Tell the patient to report any breathing difficulty immediately.
- Notify the doctor immediately if the patient develops cyanosis rapid or shallow breathing, sub- cutaneous emphysema chest pain or excessive bleeding
- When clots are visible you may be able to strip the tubing depending on your facility policy. This is a controversial procedure because it creates high negative pressure that could suck viable lung tissue into the drainage
- Check the chest tube dressing at least every 8 hours.
- Palpate the area surrounding that dressing for crepitus or subcutaneous emphysema, which indicates that air is leaking into the subcutaneous tissue surrounding the insertion site
- Encourage active or passive range of motion (ROM) exercises for the patient’s arm or the affected side if he has been splint his arm to decrease his discomfort Remind the ambulatory patient to keep the drainage system below chest level and to be careful not to disconnect the tubing to maintain the water seal.
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