JUWAK, Jassim A.

BSN – B
NCM112j – Respiratory

1. What is the difference between suction and water seal?

- When a chest drain is connected to "wall suction," it indicates that the vacuum
regulator is attached to the patient's chest drain (the device attached to the wall that
controls the suction pressure). When the water seal is engaged on the chest drain, it
indicates that the chest drain is detached from the vacuum regulator.
2. How long can you keep the chest tube in?
- The amount of time that a chest tube is required to be in place varies, but it is typically
between two and five days at the very most. Patients may be discharged from the
hospital with a chest tube in place in certain circumstances; however, in the vast
majority of cases, chest tubes are removed before patients leave the hospital.
3. How should you assess for a leak in a chest tube drainage system?
- Check for any air leaks at least once during each shift, and more frequently, if
necessary, based on how your patient's breathing is going. Examine the air-leak
detection chamber located within the water seal of the drainage device as your first
order of business. Small air bubbles are the clear indicator of a leaking air system; the
volume of bubbling reveals the severity of the problem. If you observe bubbling, you
should try to locate the source of the leak. Both outside the patient's body and inside the
patient's body are potential locations for leaks to take place (for example, within the
drain or the tubing connections) (for instance, at the tube insertion site or inside the
chest cavity). Put a clamp on the tubing that is as close to the patient as you can get it
in order to locate the source of the leak. If the bubbling does not stop, you should check
for damage to the drainage device or a leak in the tubing (as from inadvertent lowering
of the bed onto the drain). The point at which the distal end of the tube connects to the
tubing of the drainage device is typically the location at which air leaks take place. Verify
that it has not worked its way loose at this point in the process. It is recommended that
you make use of securements in this area, such as plastic fasteners (zip ties), in order
to assist in preventing accidental disconnection.
4. How many ml of drainage be considered normal?
- Patients who were undergoing an open thoracotomy with routine chest tube placement
were randomly assigned to have their chest tubes removed at an uninfected fluid
drainage level of less than 200 mL per day, less than 150 mL per day, or less than 100
mL per day, depending on how much fluid was being drained.
5. Is continuous bubbling normal in chest tube?
- When a patient with a pneumothorax exhales or coughs, an air leak can be identified
by the intermittent bubbling that occurs in the water seal chamber. On the Under Water
Sealed Drains (UWSD), a numerical grading from one to five will indicate the severity of
the leak, with one representing a small leak and five representing a large leak. If this
chamber continues to bubble continuously, it indicates that there is a significant air leak
between the drain and the patient. In addition to determining the patient's condition,
check the drain for disconnection, dislodgement, and a loose connection. In the event
that the problem cannot be fixed, the medical staff should be notified immediately. 
6. How do you care client with water seal drainage?
- If you are using suction with water-seal drainage, the system must be vented to the
outside air whenever the suction is turned off, regardless of the reason for the switch.
The intrapleural air will be able to leave the system as a result of this action. To
accomplish this, you will first need to detach the tubing that is connected to the suction
port in order to make room for an air vent. Check the water-seal chest drainage system
for patency to make sure it is operating as it should. This will ensure that it is in good
working order. Record the results of your observations in the patient's clinical record,
noting the quantity, color, and consistency of the chest drainage at the prescribed time
intervals. Keep an eye out for any kinks in the drainage tubing. In order to maintain
chest tube patency, the physician will instruct the patient to "milk" the chest tube in the
direction of chest drainage. Maintain close and attentive observation of the patient for
any indications of breathing difficulties, cyanosis, increased chest pressure, crepitus,
and/or bleeding. Check the dressing at the site where the chest tube was inserted for
any signs of air leakage or excessive drainage, and make a note of the observations.
Encourage the patient to cough and deep breathe at least every 2 hours or as ordered.
In order to facilitate drainage and avoid complications, it is important to remind the
patient to switch positions every two hours and to check that the tubing has not become
kinked and is in the correct position. In order to maintain joint mobility, you should
strongly encourage the patient to perform range of motion exercises for the affected
upper extremity. Obtain in the patient's clinical record any significant nursing
observations and communicate these to the professional nurse in charge of the patient.
REFERENCES
“2-26. CARING FOR THE PATIENT WITH WATER-SEAL CHEST DRAINAGE.” 2-26.
CARING FOR THE PATIENT WITH WATER-SEAL CHEST DRAINAGE,
nursing411.org/Courses/MD0917_Nursing_care_cardio_resp/2-
26_Nursing_Care_related_to_the_cardiorespiratory_system.html. Accessed 6 Sept.
2022.
“Managing Chest Tubes: Air Leaks and Unplanned Tube Removal.” American Nurse, 11
May 2015, www.myamericannurse.com/managing-chest-tubes-air-leaks-unplanned-
tube-removal/#:~:text=Assess%20for%20air%20leaks%20at,the%20degree%20of
%20the%20leak.
“What Is a Chest Tube Insertion Used For?” Chest Tube Insertion: Purpose, Procedure
& Risks, www.healthline.com/health/chest-tube-insertion#procedure. Accessed 6 Sept.
2022.
PT, MS, CCS, CEP, Greg Adams. “Blowing Bubbles with Chest Drains - MedBridge
Blog.” MedBridge Blog, 4 Nov. 2015,
www.medbridgeeducation.com/blog/2015/11/blowing-bubbles-with-chest-drains/
#:~:text=Wall%20Suction%20vs.-,Water%20Seal,attached%20to%20the%20vacuum
%20regulator.
SADOVSKY, RICHARD. “When to Remove Chest Tubes: Use of Volume Threshold.”
When to Remove Chest Tubes: Use of Volume Threshold,
www.aafp.org/pubs/afp/issues/2003/0215/p869.html. Accessed 6 Sept. 2022.