Underwater seal drainage

Underwater seal drainage

Purpose

· to facilitate re-expansion of the lung after surgery or trauma

· during cardio-thoracic surgical procedures

· pericardial, mediastinal and pleural drainage tubes are inserted.

Positioning of UWSD

Postero-basal = primarily for drainage from a traumatized lung.

Antero-apical = primarily for an air leak from a traumatized lung.

Principles of UWSD

Tubing from the catheter is placed under the blue Chlorhexidine 1:2000 solution and below the level of the patient's chest. This provides a water seal, so no air can enter the lung space. The fluid in the bottle should "swing" with respiration. That is the fluid should be pulled up the tube from the bottle on inspiration and it should fall on expiration. If swinging ceases, the tube may be blocked by a blood clot, the tube may be kinked or the lung may be fully expanded. Bubbling:if the patient has an air leak from the lung surface bubbles will appear in the bottle during inspiration or on coughing.

A continuous controlled low-pressure (3 k.p.a.) may be applied to the U.W.S.D. bottle to assist drainage.

Insertion of UWSD

Plastic bottle remove both caps from bottle.

Using the jug, measure and pour 300ml of blue Chlorhexidine 1:2000 into the drainage bottle to zero level. Connect larger end of tubing to the long rod of the bottle leaving the smaller end in the sterile wrap for connection to the catheter. Check that

the rod is below the fluid level but not touching the bottom of the bottle. The tube
should be approximately 2.5cm under the solution level

Equipment

Sterile HSDU Pack containing:
2 gallipots		1 10 cc Luer lock syringe
2 Howard Kelly forceps		1 20g x 2" needle
1 BP handle		1 needle holder
1 dressing forceps		1 dressing towel
1 Treeve forceps		1 area towel
1 Sharp scissor		10 Gauze swabs
2 Spencer Wells Forceps
On outside of pack:	small - large adapter	No 10 blade	Suture material: 1 Silk (4.0)

Additional equipment

Thoracic trocar & cannula	Sterile gown and gloves
Drainage bottle	Lignocaine 1% (2x5 ml)
Tubing pack	Tube dressing
Sterile measure jug	Adhesive tape
Blue Chlorhexidine 1:2000	Rubber band and safety pin
Iodine solution or persist plus swabs	Safety stand

Procedure

· position the drainage bottle in the safety stand and tuck wrapped end of the tubing under the mattress

· assist the medical officer as necessary during the procedure

· ensure that the tubing is pushed firmly onto the catheter and tape the connection between the catheter and drainage tube. Support the tubing by securing it to the bottom sheet with a rubber band and safety pin.

· dress insertion site per diagram

· place all reusable equipment in HSDU bin

· measure and chart drainage on flow chart

Using an 18cm - 8.25cm Primacore Dressing cut a slit in the centre. Apply the tape (as per diagram) to secure the tubing.

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Care of UWSD

Check the character and quantity of drainage. If drain is in the pleural space draining air, check also for oscillation (swinging of fluid in rhythm with the patient's respiration) and for bubbling of air.

Frequent observations should be made for

· kinks in the tubing

· flattening of tubing

· loosening of connections

· blockage of tubing

· tube dislodgement

Tubing should not be clamped for transport of patient. If transport is necessary, ensure the bottle is carried below the level of the patient.

Tubing should be clamped with 2 Howard Kelly forceps, above the connection only

· when it is necessary to lift the bottle above the level of the bed

· when changing the bottle on a non-ventilated patient (unclamp immediately procedure is completed and check patency of drain)

· following pneumonectomy (usually clamped for 55 min released for 5 min)

**Never clamp a bubbling UWSD