2-26. CARING FOR THE PATIENT WITH WATER-SEAL CHEST DRAINAGE
a. When using suction with water-seal drainage, the system should be open to
the atmosphere when the suction is turned off for any reason. This will allow
intrapleural air to escape from the system. To do this, simply detach the tubing from the
suction port to create an air vent.
b. Observe the water-seal chest drainage system for patency to ensure that it is
(1) Fluid in glass rod (or water seal chamber of commercial devices) should
rise and fall with respirations.
Fluctuation should continue until the lung has re-expanded.
c. Observe amount, color, and consistency of chest drainage at ordered time
intervals and record results in patient's clinical record.
Notify charge nurse immediately if chest drainage exceeds 100 cc/hour.
(2) Notify charge nurse immediately if chest drainage color changes to
(3) Mark the level of drainage on a piece of adhesive tape affixed to the
drainage system every shift, or as ordered; include date, time, and your initials.
Do not empty the drainage system unless directed to do so by the
d. Observe drainage tubing for any kinking.
Do not allow drainage tubing to loop below drainage system entry level.
(2) Fasten the tubing to the draw sheet with rubber bands and safety pins
so the flow by gravity will occur.
e. Milk the chest tube, as ordered by the physician, in the direction of chest
drainage to promote chest tube patency.
(1) Lubricate the drainage tubing with lubricant (water-soluble) for
approximately 12 inches.
(2) Pinch the tubing above the lubrication with one hand; with the other
hand compress the tubing, allowing the fingers to slide over the lubrication toward the
drainage bottle and release both hands.