![]() ![]() The water-seal bottle is the key for chest drainage, as it includes a place for drainage to collect and a one-way valve that prevents air or fluid from returning to the chest. Therefore, the degree of water seal does not increase as fluid accumulates in the drain bottle. With this system, the first bottle (closer to the patient) collects the drainage and the second bottle is the water seal, which remains at 2 cm (water seal and air vent). This system is preferred over one-bottle system when large quantities of liquid are drained from the pleural cavity. As a result, the one-bottle system works efficiently for uncomplicated pneumothorax.Īnother disadvantage of this system is that the positioning of the bottle at a level higher than the patient’s chest causes liquid passing into the pleural cavity ( 1).įor the aforementioned reasons of inefficient function of the one-bottle system in cases of pleural fluid effusion, it has been introduced the two-compartment system. ![]() Practically, this system works if only air is leaving the chest, because if fluid is draining, it will add to the fluid in the water seal, and increase the depth, and as the depth increases, it becomes harder for the air to push through a higher level of water, and could result in air staying in the chest. However, when a significant quantity of liquid is drained from the pleural cavity of the patient, the liquid level will rise, thus requiring a greater pressure on the rigid straw to remove effectively additional air from the pleural cavity to the bottle. It is clear that when the rigid straw is above the liquid level in the bottle, the system will not operate consistently developing pneumothorax. ![]() Just like a straw in a drink, air can push through the straw, but air can’t be drawn back up the straw. This system is called water seal because the water bottle seals the pleural cavity from the air or liquid from the outside of the body. If the pleural pressure is negative, it will move liquid from the bottle to the rigid straw and air will not enter the pleural cavity or the rigid straw. When the pleural pressure is positive, the pressure in the rigid straw becomes positive, and if the positive pressure in the rigid straw is greater than the depth to which the tube is immersed in the saline solution, then air will enter in the bottle and then depressurized by vent into the atmosphere. It is important to remove this valve cover before connecting the system to the patient. In order to decompress the pressure from the air leak, there is an opening of one-way decompression valve (vent) through which the system is depressurized. The other end of this rigid straw is connected to the thoracic drainage tube placed in the pleural cavity. A rigid straw is immersed into the bottle, so that its tip is located 2 cm below the surface of the saline solution, which is put into the bottle. It consists of a bottle which collects and contains the fluid and at the same time seals air leak (leakage barrier-water seal). ![]() (A) One-bottle chest drainage system (B) two-bottle chest drainage system (C) three-bottle chest drainage system (see details in the text). The understanding of this principal system introduces us to the mechanism of function. The application and development was based on the original one-bottle system. A key issue in the successful treatment of patients is the understanding of how these systems function. The basic design principle of these systems has been the avoidance of air entrance in the pleural cavity during the various phases of the respiratory cycle and continuous drainage of air and fluid from the pleural cavity. The thoracic drainage devices cover a wide range and have evolved considerably since their introduction. The system is a two-chambered or three-chambered plastic unit with vertical columns bringing measurements marked in milliliters. An underwater seal chest drainage system is used to restore proper air pressure to the lungs, re-inflate a collapsed lung as well as remove blood and other fluids. Thus, a drainage device must: (I) allow air and fluid to leave the chest (II) contain a one-way valve to prevent air & fluid returning to the chest (III) have design so that the device is below the level of the chest tube for gravity drainage. The aims for an adequate chest drainage system to be fulfilled are: (I) remove fluid & air as promptly as possible (II) prevent drained air & fluid from returning to the pleural space, restore negative pressure in the pleural space to re-expand the lung. Pressure around the lungs is lower than atmospheric pressure outside the body. ![]()
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