CHEST TUBE and WATER-

SEAL DRAINAGE
By: Ghada J. Al-Omaireen
Objectives
 Introduction
 Chest drainage system
 Indications
 Chest drainage insertion
 Types of drainage system
 Nursing managements
 References
Normal Breathing Mechanism
 Operates on the principle of negative pressure
 Pressure in the chest cavity is lower than the

atmosphere, causing air to move into the lungs

during inspiration.
 When chest is opened, there is loss of negative

pressure which can collapse a lung.

Chest Drainage Systems
 Crucial intervention for improving gas exchange and
breathing
 Chest drainage therapy involves the removal of air,
blood, pus, or other secretions from the chest cavity.
 Installing a chest drainage tube can be either an
emergency or a planned procedure.
 Removing air or fluids from the chest involves the
insertion of a tube through the skin and the muscles
between the ribs, and into the chest cavity.
 This cavity is also called the pleural space.
Who May Need One
 Conditions that may need to be treated by chest
drainage therapy include:
 Pleural effusion (excess fluid that accumulates in
the pleura)
 Tuberculosis
 spontaneous pneumothorax that causes more than a
25% collapse of the lung.
 cancer that causes excessive secretions
 Hemothorax (blood in the thoracic cavity)
Who Needs One Continues

 Empyema (pus in the thoracic cavity)

 Oftentimes an x ray is performed prior to treatment
to determine whether the problem is either fluid or
air in the pleural space.
Types of Chest Tubes
 Small-bore
 One way valve apparatus to prevent air from moving
back into the patient
 Inserted through small incision
 Large-bore
 Usually connected to a chest drainage system to collect
any pleural fluid and monitor for air leaks.
Chest Drainage Insertion
 Most patients are awake when the chest
drainage tube is inserted.
 They are given a sedative and a local anesthetic.

 Chest drainage tubes are usually inserted

between the ribs.

 The exact location depends on the type of

material to be drained and its location in the

lungs.
Continued
 The chest drainage system must remain sealed to
prevent air from entering the chest cavity through
the tube.
 One commonly used system is a water-seal
drainage system, comprised of three compartments
that collect and drain the fluid or air without
allowing air to backflow into the tube.
 Once the tube and drainage system are in place, a
chest x ray is done to confirm that the tube is in the
right location, and that it is working.
Types of Drainage Systems
 Traditional water seal
 3 chambers, collection, water seal (middle)

and wet suction control

 Requires sterile fluid be instilled into water

seal and suction chamber

 + and – pressure release valves
 Intermittent bubbling indicates system is

functioning properly
Types Continued
 Dry suction water seal
 3 chambers like traditional
 Requires sterile fluid be instilled in water seal

chamber at 2-cm level

 No need to fill suction chamber with fluid
 + and _ pressure release valves
 Indicator to signify suction pressure is adequate
 Quieter than traditional
Types continued
 Dry suction
 One way mechanical suction that allows air to

leave the chest and prevents from moving back

into chest
 Also referred to as one way valve system
 No need to fill suction chamber with fluid, can be

set up quickly in emergency

 Works even if knocked over, great for ambulatory

patients
Special Considerations
 Newborns may develop multiple pneumothoraxes
requiring multiple chest tubes.
 Units have smaller collection chambers and finer
calibrations to allow more accurate measurement of
small drainage volumes.
 The connecting tube has a narrower diameter to
allow connection to the smaller chest tubes used in
these patients.
Nursing Management
 Ensure drainage tubing does not kink, loop or
interfere with the patient’s movements to prevent
fluid back up into the pleural space or impede
drainage.
 Assist patient with range of motion to reduce post
op pain and prevent ankylosis of the shoulder.
 Milk tubing in direction of drainage system as
needed to prevent tubing from becoming obstructed
by clots and fibrin.
Nursing Management Continued
 Make sure there is fluctuation of the fluid level in
the water seal chamber, shows effective connection
 Fluid fluctuations in the water seal chamber or air
leak indicator are will stop when
 Lung has reexpanded
 Tubing is obstructed
 Lop of tubing hangs below rest of tubing
 Suction motor or wall suction is not working
Nursing Management Continued
 Monitor for air leaks to prevent tension
pneumothorax.
 Notify MD if excessive bubbling in water seal
chamber not due to external leaks.
 Assess for rapid and shallow breathing, cyanosis,
pressure in chest, symptoms of hemorrhage to
significant changes in VS
 Encourage deep breathing a coughing to help aisle
pleural raise and promotion of accumulated fluid in
pleural space.
Nursing Management Continued
 Keep system below chest level
 Keep suction at prescribed level
 Keep air vent open when suction is off.
 Never let the drainage tube dangle. As part of your
routine care, make sure it's coiled on the bed.
Nursing Management Continued
 Pneumothorax, expect little if any output because the
tube is draining air, not fluid.
 Hemothorax, a lack of drainage may indicate a clot
obstructing the tube. If that occurs, try milking the
tube: Starting at the proximal end, gently squeeze and
release it between your fingers along the length of the
tubing.
 However, don't “strip” the chest tube, which means
squeezing the length of the tube without releasing it.
Once a common practice, stripping the tube causes a
dangerous increase in intrathoracic pressure and
doesn't lead to any significant increase in output.
Milking
References
 http://www.nlm.nih.gov/medlineplus/ency/article/0
02947.htm
 http://www.livestrong.com/article/194867-complic
ations-from-chest-tubes-for-drainage/#ixzz1HcVQj
8mc

 http://www.medtrng.com/blackboard/chest_tube_ca
re_and_monitoring.htm
Thank You