WATER SEAL

DRAINAGE
Lung
Anatomi rongga pleura
Dibentuk oleh :
 Membran serosa yang kuat berasal dari mesoderm

 Pleura parietalis. Lapisan pembungkus rongga dada

bagian dalam
 Pleura visceralis, Lapisan pembungkus paru

 Tebal rongga pleura 10 – 20 mikron

 Berisi cairan 25-50ml, berfungsi sebagai pelicin

 Mengandung rendah protein.

PHYSIOLOGY OF VENTILATION

Inspiration is active Expiration is

passive
N :-2 to -5 mmHg N : - 8 mmHg
Normal breathing
 Respirasi
Pertukaran gas, Respirasi eksternal adalah pertukaran
gas dalam paru, sedangkan respirasi internal adalah
pertukaran gas pada level selular antara darah dan
sel organ dan otot
 Ventilasi
Pergerakan udara masuk dan keluar paru dan
terjadi karena adanya perbedaan tekanan
Water Seal Drainage
Chest Drainage System

 Tujuan
Mengeluarkan udara, darah dan cairan lain dari
intrapleura atau rongga mediastinal

Menstabilkan tekanan negatif intrapleura

Indikasi
 Pneumothorax  Pleura Effusion
Spontaneous  Hemothorax
Traumatic
 Cardiac Tamponade
( Close and Open )
 Thorax Surgery
Iatrogenic
Tension
Pneumothorax
Pleural Effusion
Pericardial Effusion
Pericardial Effusion
KONTRA INDIKASI

 Refractory Coagulopathy
 Lack of Cooperation by the patient
 Diaphragmatic Hernia
 Scarring in the pleura space
KOMPLIKASI
 Perdarahan
 Infeksi
 Pulmonary Edema
 Chest tube clogging
 Subcutaneous hematoma
WSD Systems
 Collection Chamber
The patient tubing connects the drainage unit directly
to the chest tube

 Water Seal Chamber

The main purpose of water seal is to allow air to exit
from the pleura space on exhalation and prevent air
from the entering the pleura cavity or mediastinum on
inhalation
 3 mekanisme sistem drainase

1 Gravitasi
Aliran udara dan cairan berjalan dari tekanan yang lebih
tinggi ke tek. Yang rendah.
2 Tekanan Positif
Memberikan tek. + yang lebih rendah dari tek. + dalam
rongga dada, sehingga udara akan bergerak dari tek. tinggi
ke tek. rendah pada water seal
3 Suction
Menarik tek. Atmosfir menjadi lebih rendah dalam water
seal sehingga udara / cairan akan bergerak ke dalam water
seal
Disposable Drainage Units
Wound care
Pro and contra
Nine steps to chest drain assessment
• Check dressing and connections
• No dependant loops
• No milking or striping
• Check drainage
• Check bubbling
• Check swing
• Check water levels
• Adjust bubbling
• Check all ports are open
Attention
 If suction is
discontinued, the suction tube or port should remain
UNCAPPED and free of OBSTRUCTIONS to allow
air to exit and minimize the possibility of tension
pneumothorax.
Clamped or Unclamped …..?
 The decision whether to clamp a chest tube when
the drainage system has been knocked over and
disconnected or otherwise disrupted is based on
your initial assessment of the water seal chamber
and air leak meter. If there has been no bubbling
in the water seal, you can deduce there is no air
leak from the lung. Therefore, the tube may be
clamped for the short time it takes to reestablish
drainage
Clamped or Unclamped …..?
 If there has been bubbling and your assessment
has determined there is an air leak from the lung,
you MUST NOT clamp the chest tube.

 Doing so will cause air to accumulate in the

pleural cavity since the air has no means of
escape. This can rapidly lead to tension
pneumothorax.
Clamped on …..
 You are performing a physician-ordered
procedure such as sclerosing

 Assessing for a leak,

 Prior to removing the chest tube to determine if

the patient can do without the chest tube (with a
physician order).
Attention

 You should never clamp a chest tube

during patient transport unless the chest
drainage system becomes disrupted
during patient movement, and then
only if there is no air leak.
Indikasi pencabutan WSD

 Paru sudah mengembang : no air leak has developed

during 24 – 48 hr period
 Less than 150 ml 0f fluid has drained in 24 hr
periode. If chest tube produced blood:
< 3 cc / Kg BW / hr Observation

 3 – 5 cc / Kg BW / hr
Be ware, observation

 > 5 cc / Kg BW / hr operation / exploaration