Caring of WSD

WSD'S concept
A.  Water Seal Drainage's concept (WSD)
1.   Savvy
WSD constitutes invasive's action that is done to issue air, liquid (blood, pus) of pleura's cavity by use of link pipe.

Image 2. 1 WSD'S pipe Assembly
2.  To the effect
a.       Stream / drainage airs or liquid of pleura's cavity to keep that cavity negative pressure.
Image 2. 2 Drainage Airs Or Liquids Of Pleura's Cavities
b.      Developing paru's back that kolaps
c.       Inserting doctor into pleura's cavity.
3.      Pleura's Cavity pressure change
Pressure
    
Rest
    
Inspiration
    
Ekspirasi
Atmosfir
    
760
    
760
    
760
Intrapulmoner
    
760
    
757
    
763
Intrapleural
    
756
    
750
    
756

4.  WSD'S Assembly indication
a.      Hematotoraks
b.      pleura's effusion with ferocity
c.      Pneumotoraks is more than 20 %
d.      Hidropneumothoraks
e.      Empiema

Image 2. 3 Pneumotoraks


Image 2.4 Radiologis Pneumotoraks's Pictures
Image 2. 5 Pleura / Empiema / Hematotoraks's Effusions
Image 2. 6 Radiologis's Pictures Pleura's Effusions

5.  Assembly Indication con WSD
a.       Hematothoraks is massif that haven't gotten liquid substitution / blood
b.      Blood coagulation trouble that doesn't be controlled
c.       About juxtaposition pleura that extensive.

6.  WSD'S Assembly place
a.  A part Apex Paru
Which is on anterolateral intercosta 1 2 one functions to issue airs of pleura's cavities.
b.  A part Dropsy
Which is on 8th posterolateral intercosta 9 one functions to issue liquids (blood, pus) of pleura's cavity.

7.  WSD'S types
a.  WSD with system one bottle
Simplest and frequent system is utilized on simple pneumothoraks's patient. Consisting of bottle with closing signet that have 2 pipe hole which is 1 for ventilation and 1 again turns in at bottle. Sterile water at entry into bottle until pipe tip is soaked two cm to shut-out it airs into tubed causative kolaps paru. After for bottles deep ventilation be let open end for memfasilitasi to air from pleura's cavity comes out. Drainage depends from exhalation and gravitation mechanism. Undulasi on after liquid beats time exhalation.
b.  WSD with system two bottles
Utilized two bottles,  one bottle gathers drainage's liquid and second bottle as water seal. Bottle 1 linked with drainage's pipe that initially empty and air-less, after short on bottle 1 linked with pipe at bottle 2 one contains water seal. Drainage liquid of pleura's cavity comes in to go to bottle 1 and air of pleura's cavity comes in to go to water seal bottle 2. cooperative Principles with system one bottle which is air and liquid is adrift from pleura's cavity goes to WSD'S bottle and dipompakan's air comes out to pass through input pipe goes to WSD. Bisasanya is utilized to settle hemotothoraks, hemopneumothoraks and peura's effusion.
c.  WSD with system three bottles
Equal to system 2 bottles, added 1 bottle to control sip amount that is utilized. Best of all safe to manage sip amount. One that primal is pipe depth under water on 3rd bottle. Total sip clings to pipe tip depth that imbedded deep WSD'S bottled water.  Drainage depends gravitation and enhanced sip amount. Bottle 3rding to have 3 pipes which is tube short upon linked watershed with tube on second bottle,  tube is other short to be linked by suction and tube in the middle that elongated comes unto water level bounds and open end to atmosphere.
Image 2. 7 WSD'S Bottles
Image 2. 8 Suction Continous WSD
8.  WSD'S Assembly complication
a.       Laserasi, mencederai is organ (hepar, lien)
b.      About blood
c.       Empisema Subkutis
d.      Tube escapes
e.       Infection
f.        Tube is jammed

9.  WSD'S Assembly preparation
a.  Pengkajian
1 ) Reexamine doctor instructions
2 ) Crosses A Cheque inform consent
3 ) Mengkaji bear evidence of vital and patient respiration states.
b.  Patient preparation
1 ) Make Ready patient
2 ) Give explanations to patient cover:
a ) action Aim
b ) body Position while actions and up to rigged WSD,   client position can sit or reclining
c ) efforts to reduce ache excitement as breathing as deep and distraksi
d. ) thoraks posterior anterior's Photograph and lateral paru.

c.   Tool and material preparation covers:
1 ) Trokar / drain's thoraxs with number that adjusted by material who will be streamed, to air number 18 20 and for pus number 22 24.
2 ) sterile Wire-nettings
3 ) Plasters
4 ) Alcohols 70% and bethadin 10%
5 ) Spuit 5 cc as much 2 numbers
6 ) Lidocain Solusio hypodermics for local's anaesthesia as much 5 ampuls
7 ) WSD'S Bottles
8 ) One tables with one set surgical operation minor
9 ) sterile Kerchiefs
10.   Action procedure
a.        Patient position with nurginal one takes ill to had up towards doctor with disandarkan on inclination 30o 60o, paru's nurginal hand that sick appointed onto head
b.        Does antiseptic's action utilize bethadin 10% is drawned out by use of alcohols 70% by pirouettings towards outer, assemble sterile kerchief with place hole whereabouts will do insersi catheter
c.        Do local anesthesia endue to endue from skin until pleura parietalais utilizes lidocain solusio hypodermic, don't forget to do aspiration before issue doctor on each coat. Anaesthesia is done on region who will at WSD'S tide or on intercostalis 4 5 anterior from mid axillary lines
_.        Directly does punksi attempt utilize spuit that anaesthesia
e.        Do slicing on memanjang's skin on a line intercostalis more or less 1 cm then dull ala open gets to pleura
f.          Made ready by matras's stitching drawns round catheter
g.        One hand pushes trokar and memfiksir trokar's another hand to draw the line its input tool into pleura's cavity. After trokar turns in at pleura's cavity, stilet is snipped off and trokar's hole at closes by thumb. Catheter already at clamp at the end distalnya at insersi rapid fire melelui trokar into pleura's cavity. Catheter was presented at by anteroapikal on pneumothoraks and posterobasal on liquid pleura / empiema. Trokar is taken down on chest wall. distal's sectioned catheter is taken down and trokar is issued
h.        After trokar is pulled, link catheter with after and inserts pipe tip into WSD'S bottle already been given bethadin's solution already been thinned by NaCl 0,9% and ensure pipe tip be soaked along two cm
i.          Looking at marks sense undulasi on after link and available liquid, blood and pus which is streamed or air bubble on WSD'S bottle.
j.          Catheter fixation with stitching tabbac sac, then close with sterile wire-netting already at gives bethadin and fixation goes to chest wall by plaster.
 (Diagnosis default & Emergencies Dangerous therapy, 2007:  70 - 72)
11.  Repeal guidance
a.   Repeal criterion:
1 ) sekrit serous, not hemoraged
2 ) Adults: total less than 100cc / 24jam
3 ) Child – childs: total less 25 50cc / 24jam
4 ) Paru Mengembang with sign:
a ) Auskultasi vesikuler's breath voice left and right
b ) sonor's sound Percussions left and right
c ) Fibrasi symmetrical left and right
d. ) paru's thorax Photograph that sick have mengembang
b.        Condition of:
1 ) On trauma
Hemato / pneumothorak already accomplishes both of criterion,   directly been snipped off by tight's water (hermetically).
2 ) On thoracotomi
Infection: preceding clamp 24 hours to prevent resufflasi, if good pulls out
3 ) Post Operatif: if second criterion pock, langsug at pulls out (tight's water)
4 ) Post Pneumonektomi: drd day if mediastinum stable (not necessarily tight's water).
c.        Alternative
1 ) Paru makes a abode kolaps, suck until 25 cmH20
2 ) If both of krieria is accomplished, preceding clamp 24 hours, good regular does repeal.
3 ) If unsuccessful, sit out until two weeks, does dekortikasi
4 ) sekret is more than 200cc / 24jam: suspect marks sense Chylo thorax (ensure with laboratory check), stick out for until with four weeks, if fails to be done by toracotomi
5 ) If sekret less than 100cc / 24jam, clamp, then is snipped off.

C.     WSD'S care concept

    Tool preparation:

a.       One table with one set surgical operation minor
b.      WSD'S bottle contains bethadin's solution already been thinned by NaCl 0,9% and pipe tip are soaked along two cm.
c.       Sterile wire-netting in tromol
d.      Korentang
e.       Plaster and snip
f.        Nierbekken / is gross wrapping bag
g.       Alcohol 70%
h.       Bethadin 10%
i.         Sterile Handscoon
2.  Patient preparation and Environmentally
a.       Patient and family was given by explanation about action which will be done
b.      Put together sampiran looked around by bed
c.       Free dress upper patient
d.      Managing position a half seat or accords patient ability
e.       didekatkan's tools goes to patient beds.
3.  WSD'S care performing
a.       Nurse washes to put hand out, then assembles handscoon
b.      Opening set minor's surgical operation sterile
c.       Opening wrapping by use of pinset carefully,    gross wrapping to be inserted into nierbekken
d.      Mendisinfeksi is wound and after with alcohol wire-netting 70% then with bethadin 10%
e.       Shut up wound with sterile wire-netting already been cut its mean then plastered
f.        After WSD at clamp
g.       Releasing thread among after WSD with after bottle
h.       WSD'S pipe tip cleared by alcohol 70%, then WSD'S pipe is linked with penyambung's pipe WSD'S bottle a new one
i.         WSD'S pipe clamp is opened
j.        Advise patient to inhale deep and leads trick patient cough effective
k.      Coach and advise patient for routinely 2 3 times one day do power training on about joint shoulder WSD'S assembly region
l.         Neaten dress patient and its environment, then helps patient in the most positioning cozy
m.     Clearing WSD'S tool and bottle that gross, then at back pasteurization
n.       Opening handscoon and washes hand
o.      Writing procedure already being done on care note.
3.      Care Performing evaluation WSD
Care performing evaluation WSD covers:
a.       Generality evaluation:
1 ) patient complaint Observations
2 ) sianosis's phenomena Observation
3 ) sign Observations about bloods and falt low on chest
4 ) Observation what there is krepitasi on curries around WSD'S pipe
5 ) vital's auspices Observation.
b.  paru's expansion evaluation covers:
1 ) Do paru's Inspection check after finish do WSD'S cares
2 ) Do Palpasi Paru's checks after finish do WSD'S cares
3 ) Do paru's Percussion check after finish do WSD'S cares
4 ) Do Auskultasi Paru's checks after finish do WSD'S cares
5 ) thoraks's Photographs after been done WSD'S pipe assembly and before pipe WSD at takes down.
c.  WSD'S evaluation covers:
1 ) undulasi's Observations on after WSD
2 ) suction countinous's logistic Observations
3 ) Observations if WSD'S pipes is jammed or is folded
4 ) Note total secretory liquids of WSD'S bottles
5 ) stick out for pipe tip in that WSD'S bottle always lies 2 cm under water
6 ) stick out for that WSD'S bottle always inferior of body
7 ) WSD'S bottle Replacing everyday or if was full. (Praktik's skill guidance Clinic to care. 2005: 49 - 50).











REFERENCE LIST

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SMF Paru RSUD Ulin Banjarmasin. 2007. Diagnosis default & Emergencies Dangerous therapy. Banjarmasin

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Foundation ten care Academy Junes Odoriferous Screw Pines, 2005. Practicing skill guidance Clinic to care. Banjarmasin

Murjani, 2010. Care Performing picture WSD to Paru's Disease by Nurse at RSUD Ulin Banjarmasin 2010. STIK Muhammadiyah Bajarmasin