Nursing Care Related to the
Cardiovascular and Respiratory Systems
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 functioning properly.
c. Observe amount, color, and consistency of chest drainage at ordered time intervals and record results in patient's clinical record.
d. Observe drainage tubing for any kinking.
e. Milk the chest tube, as ordered by the physician, in the direction of chest drainage to promote chest tube patency.
f. Observe the patient carefully for any signs of respiratory difficulty, cyanosis, chest pressure, crepitus, and/or hemorrhage.
g. Check to see that the drainage bottle is secured to the floor or is in a special holder.
h. Observe the dressing at the chest tube insertion site for air leakage or excessive drainage and record findings.
i. Encourage the patient to cough and deep breath at least every 2 hours or as ordered.
j. Encourage the patient to change position every 2 hours to promote drainage and prevent complications; make sure tubing remains free from kinks and is in proper position.
k. Encourage the patient to perform range of motion exercises for the affected upper extremity to maintain joint mobility.
l. Transport or ambulate a patient with a chest tube carefully, keeping the water-seal unit below chest level and upright at all times.
m. As indicated, provide emergency care to the patient if the water- seal unit becomes broken or emptied.
n. As indicated, provide emergency care to the patient if the chest tube becomes disconnected from the drainage system.
o. As indicated, provide emergency care to the patient if the water- seal unit is tipped over.
p. As indicated; provide emergency care to the patient whose chest tube has accidentally been pulled out of the chest wall.
q. Record significant nursing observations in the patient's clinical record and report the same to the professional nurse.
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