chest tubes

Esme12, ASN, BSN, RN · Mar 21, 2013

We are happy to help with homework but we will not do it for you.....what do you think? Tell us what you think so we can best help you to find the best answer yourself?

chloe071 · Mar 21, 2013

Well I'm a new nurse... I thought water seal meant not connected to wall suction. While getting report I even asked the nurse if it was to wall suction and she said no. Well while rounding with my pt, she was connected to the wall suction...so it kind of got me confused

MunoRN, RN · Mar 21, 2013

I've always found this terminology annoying. Really, whether hooked up to suction or not, a patient hooked up to a drainage system that utilizes a water seal is always on water seal, regardless of whether or not it's on suction. But according to our (poorly thought through) terminology, yes you are correct that "to water seal" usually refers to no suction. While you could set the drain to -40cm h20, you wouldn't actually achieve that without suction.

hodgieRN · Mar 21, 2013

The terminology is actually very clear.

The difference in suction and no suction is termed "to suction or to gravity." If the CT is to suction, then it is causing a negative pressure to suction fluid into the collection chamber. If it is to gravity, then it is passively draining into the chamber.

If you are in report and you want to know if the CT is to suction or not, you ask "Is the chest tube to suction or is it to gravity?" If it is to gravity, then it is not on suction. There will be an order in the chart that specifies if the CT should be to suction or to gravity. If the CT is ordered to gravity, and the chest tube is to suction when you go in the room, then the nurse failed to follow the doctor's order. You should question that during report after looking at the order.

hodgieRN · Mar 21, 2013

All pts in the hospital have a water seal. The water seal prevents back flow into the chest and it indicates if there is a leak. It is usually at the bottom of the collection system and the water is dyed blue. You can also look at the water seal chamber to see if there is fluctuation with respiration. It verifies the pressure variance with inhalation and exhalation. Unless, there is a specific collection system that doesn't have the seal (maybe some type of take home system), all CT systems have a water seal.

The confusion you are getting is the suction chamber. And the terms are either a dry suction water-seal or a wet suction water-seal system. It's not water seal vs dry suction. That's one half of two equations. Nurses sometimes don't specify the right terms. It's either dry suction or wet suction and they both have water seals.

This is a dry suction water seal. Notice the only water in the system is the water seal. It that chamber bubbles, there's a leak. There is no water suction chamber (wet). The dry suction systems have an orange plunger that pops out with suction and you can change the suction to -20 to -40 by turning the dial. So, there are only two chambers...the water seal and the collection chamber.

This a water seal, wet suction. Notice there are 3 chambers. The collection on the right, the water seal in the middle bottom and the suction chamber on the left. You change the -20 to -40 by how much water you fill on the left. Hence the term wet suction. That chamber will bubble depending on how much wall suction you provide. The water seal chamber shouldn't bubble unless there is a leak. Here's another wet suction....

Here is why a water seal is on all systems, regardless or wet suction or dry suction...

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The middle stops air from back flowing and the right chamber offers pressure, while the first chamber catches drainage. Notice the tubes on the right are not submerged. If the water seal wasn't there, the air would love freely back and forth. The water seal ensures only one direction of air. It is the only submerged tube.

So, the terminology is very clear. You will need to know if the system is a wet suction water seal or a dry suction water seal. Then you will find out if the it is hooked up to suction or if it is to gravity. If it is to suction, find out how much suction is required...-20 h2O, -30 h20 or -40 h20. If the nurse says water seal or dry suction, that doesn't say anything.

PRN_NURS · Mar 31, 2013

HodgieRN is absolutely correct,

The wet seal is essentially the original way of chest tube suctioning, and the last picture provided is exactly what the chest drainage devices use to look like.

Just a point to remember, when there are air bubbles in the water seal/air leak meter it does not always mean there is a leak; Know what is being drained from the pleural space because when draining a pneumothorax there should be air bubbles present (though they should be decreasing as time goes on).

as well, when using dry suction, be sure the suction monitor bellows indicates that suction is in fact working (i have seen this as a accordion type spring, as seen in first pic above, and as a check mark). When using wet suction, be sure the suction control chamber is not only set to the right pressure, but that there is a constant, gentle stream of bubbles through it, this indicates suction is working properly.

cheers

Esme12, ASN, BSN, RN · Apr 2, 2013

Hodgie is right.....This may help....Chest Drainage Systems