Policy Manual sample

MDT Home Health Care Agency, Inc. The second chamber functions as an underwater seal (UWS), which is a one way valve that allows air to exit the chest and prevents air returning to the patient. Air bubbling through the water seal chamber intermittently is normal when the patient coughs or exhales, but if there is continuous air bubbling in the chamber, it can indicate a leak that should be evaluated. The water seal chamber is connected in series to the collection chamber, and allows air to pass down through a narrow channel and bubble out through the bottom of the water seal. Since air cannot return to the patient, an UWS is considered one of the safest ways of protecting the patient, in addition to being a very useful diagnostic tool. The UWS column is calibrated and acts as a water manometer for measuring intrathoracic pressure. As changes in intrathoracic pressure occur, fluctuation in the water level can be observed in this calibrated column. Such fluctuations provide the clinician an indication of how the patient is progressing. Suction Control The use of suction helps overcome an air leak by improving the rate of air and fluid flow out of the patient. The simplest and most cost effective means of controlling suction is by using a suction control chamber, which is an atmospherically vented section containing water and is connected in series with the water seal chamber and collection chamber. By adding or removing water in the suction control chamber, the chest drain effectively controls the amount of suction imposed on the patient. The lower the water content, the lower the imposed suction. The higher the water level, the higher the imposed suction. Essential Differences between Wet and Dry Suction Control Systems Wet suction control systems regulate suction pressure by the height of the column of water in the suction control chamber. The amount of negative pressure that is transmitted to the patient's chest is determined by the height of water in this chamber, not the level of vacuum set on regulator. Dry suction control systems regulate suction pressure mechanically rather than with a column of water. Setting Up a Traditional (Wet) Water Seal System The nurse will need to set up the chest drainage unit according to the manufacturer's instruction and the type of chest drainage unit used. With a tradition water seal system, follow these steps: Step 1: Fill the water seal chamber to the specified level from the manufacturer (which is usually the 2 cm mark). Step 2: Fill Suction Control. The physician will order the amount of suction (e.g., Chest tube to - 20 cm H2O). The nurse would then fill the suction control chamber with sterile water to the water level that is marked, -20 cm H2O. This level is then documented. Step 3: Patient Connection. Remove patient tube connector cap and insert stepped connector into patient catheter. Remove the connector for “Y” connector insertion. If desired, use of nylon bands around catheter and patient tube connections will provide added security and assure an air-tight connection. The chest drain should be connected to the patient prior to initiating suction. Step 4: Applying suction. The tubing on the suction control chamber is attached to the wall suction. The nurse should start with a lower suction level and gradually increase suction until a gentle bubbling in the suction control chamber is noticed. Adjust the suction control stopcock or suction control source as needed to increase or decrease suction control bubbling. To operate the suction container at -20 cm H20, wall suction must have at least -80 mm Hg of vacuum. Step 5: Open suction control stopcock. The suction control stopcock conveniently regulates vacuum to the chest drain. It provides control of suction bubbling and allows efficient use with any unregulated suction Home Health Agency Nursing Care & Procedures K-212