Underwater seal how does it work

Walcott-Sapp, Sarah. Roe, Benson B. Perioperative management in cardiothoracic surgery. Little, Brown Medical Division, Underwater seal chest drain system.

Previous chapter: Thoracocentesis: the chest drain Next chapter: The "Guedel" style oropharyngeal airway. All SAQs related to this topic. All vivas related to this topic. Single chamber underwater seal chest drain The single bottle system is exactly that. What are the advantages of the single bottle pleural drain? Simple Cheap Easily improvised from unrelated equipment For simple pneumothorax, there is usually no need for anything more sophisticated The fluid level i.

This system obviously has a few problems: It is unsuitable for draining pleural fluid. Air will vent out of the single bottle effortlessly, but any fluid drained will collect in the bottle, increasing the fluid level. As the fluid level rises, the pressure required to force air and fluid out of the chest cavity increases; i. If pleural fluid goes enter the bottle, froth will form. Protein from the pleural space tends to foam due to the bubbling of the drain, which fills the chamber with froth.

This makes the level of the fluid difficult to read, and is aesthetically unappealing. Fluid may reflux into the patient's chest cavity. As long as this bottle remains well below the level of the patient's pleural space, no fluid will get sucked up into the chest. If the bottle is held above the level of the chest, everything inside it may regurgitate back into the pleural cavity, with non-hilarious consequences.

The two-chamber underwater seal pleural drain This system separates the fluid collection chamber from the water seal chamber. So, the advantages of this thing are: Fixed underwater seal level , therefore consistent low resistance to air expulsion Pleural fluid and water seal are separate: therefore, no froth will form.

The collection bottle permits the drainage of pleural fluid , so the case uses of this system are not limited to pneumothoraces. There are of course disadvantages: It is less efficient at draining air cavities. When the patient arrives, a conventional underwater seal drain needs to be attached quickly. And to the right wall vacuum source. Sometimes it may happen, that a high-vacuum source is attached accidentally.

Additionally, the vacuum source must be attached to the right port of a chest drain. New nurses may be overwhelmed with the amount of connections possible on underwater seal drains and due to the rare incident of having a chest drain patient so that they attach suction to the wrong port.

When the patient arrives, the chest drain unit must be placed below the patient's chest to ensure proper functioning. As these plastic boxes are placed on the floor next to the patient, it is commonplace that they are knocked over. This may have an impact on the function or on the calculation of the fluid drained. Depending on the underwater seal drain use, a priming of the water seal chamber is necessary. This needs to be done before the patient is attached. Also, this level needs to be checked on a frequent basis, to make sure the water seal function stays upright and working.

Chest drain units with water vacuum gauges need to be checked on the water level to ensure the pressure arriving at the patient. Often nursing staff thinks that the pressure set on the wall vacuum source and prescribed by the surgeons is the pressure the patient gets. However, this is not always the case. Publications reveal that the pressure the patient actually gets is dependent on various factors, such as :. And finally, during use, it is vital to regularly check the underwater seal drain to make sure there are no leaks in the system, no disconnections or an excess of fluid collected.

These factors must be recognized when handling conventional underwater seal drains. Click here to read more on the patient's perspective or see below the surgeon's perspective. During chest drainage the patient's progress must be monitored. Often this is done on an hourly basis or over a period by recording air leak and drained fluid.

But even so, this is only a snap-shot of the situation. Only by consulting the manually charted values the physician can see the patient's progress, considering the quantity of bubbles was interpreted correctly.

An additional day of pain and dependency for the patient. Based on these criteria, the decision making on when to remove a drain or when to intervene is greatly simplified. Cut tails of suture about 2cm from knot If there is no purse string present remove drain and quickly seal hole with occlusive dressing Instruct patient to breathe normally again Apply occlusive dressing bandaid for cardiac children over site Remove and discard equipment into a yellow infectious waste bag and tie Perform hand hygiene Post Procedure Care Attend to patients comfort and sedation score as per procedural sedation guideline CXR should be performed post drain removal Patients in PICU may wait until routine daily CXR if clinically well Clinical status is the best indicator of reaccumulation of air or fluid.

Clean ends of drain and reconnect. Ensure all connections are cable tied. If a new drainage system is needed cover the exposed patient end of the drain with sterile dressing while new drain is setup.

Ensure clamp removed when problem resolved Check vital signs Alert medical staff Accidental drain removal Apply pressure to the exit site and seal with steri-strips. Place an occlusive dressing over the top Check vital signs Alert medical staff. Purse string cut or not present Small bore drains such as pigtails do not require purse strings.

Simply apply an occlusive dressing. For large bore drains: Pinch or apply pressure to the exit site Apply steri-strips to close exit site and cover with an occlusive dressing Notify the responsible medical team to review patient and consider need for a suture A VHIMS must be completed by the nurse delegated to remove the drain.

Unable to remove chest drain If the drain is unable to be removed with reasonable traction being applied, notify the responsible medical team Retained drain during removal If the tube fractures during drain removal and remnants of the tubing is left within the patient contact the treating team A chest x-ray should be conducted as soon as possible. The piece of drain tubing that remains in the patient will also be kept once surgically removed to allow for appropriate follow up of the incidents cause.

Nursing management of chest drains: a systematic review. Australian Critical Care. Phildelphia: W. Saunders Company.

Managing a chest tube and drainage system. AORN Journal. European Journal of Cardiothoracic Surgery. Are chest radiographs routinely necessary following thoracostomy tube removal? Pediatric Radiology. An evidence based approach to drainage of the pleural cavity: evaluation of best practice. Journal of Evaluation in Clinical Practice.