If the tube is dislodged from the patient, immediately cover the site with a sterile occlusive dressing taped on three sides and notify the provider.
Before you read
Test yourself first: 5 questions
Question 1 of 5
A nurse is performing high-quality chest compressions on an adult during a code. Which technique reflects current best practice?
Answer: A. High-quality adult compressions are at least 2 inches (5 cm) deep, at a rate of 100 to 120 per minute, allowing full chest recoil between compressions and minimizing interruptions. Leaning on the chest between compressions impairs venous return and reduces effectiveness.
Question 2 of 5
While performing CPR, the nurse notes the chest is not fully rising back up between compressions. Why is full chest recoil important?
Answer: B. Allowing complete chest recoil lets the heart refill with blood between compressions, improving venous return and the effectiveness of the next compression. Leaning on the chest reduces cardiac output.
Question 3 of 5
A client with chest trauma develops sudden severe dyspnea, absent breath sounds on the right, tracheal deviation to the left, and hypotension. What is the priority intervention the nurse anticipates?
Answer: A. These findings indicate a tension pneumothorax, a life-threatening emergency. Immediate needle decompression (needle thoracostomy) relieves the trapped air and restores venous return, followed by chest tube placement. Delaying for a chest x-ray could be fatal.
Question 4 of 5
During adult CPR, at what depth should the nurse compress the chest?
Answer: C. Adult chest compressions should be at least 2 inches (5 cm) but not more than 2.4 inches (6 cm) deep, allowing full recoil between compressions.
Question 5 of 5
A client with a chest tube has the drainage system knocked over and the water seal disrupted. The nurse FIRST:
Answer: B. Re-establish the water seal: set the unit upright and ensure the water-seal chamber is correct (or place the tube end in sterile water per policy if disconnected), assess the client's breathing, and notify the provider. Clamping the tube can cause a tension pneumothorax.
Keep the streak going with more questions like these, each with a full rationale.
What is chest tube management?
The closed drainage system has a collection chamber, a water seal chamber, and a suction control chamber. Safe management protects the airway and prevents reaccumulation, infection, and tension pneumothorax.
Key points to remember
- Gentle continuous bubbling in the suction control chamber is normal and reflects ordered suction; vigorous bubbling means suction is too high.
- Tidaling (fluctuation of fluid in the water seal chamber with respiration) is expected and confirms patency.
- Continuous bubbling in the water seal chamber indicates an air leak in the system or patient.
- Cessation of tidaling can mean the lung has re-expanded or the tube is kinked, clamped, or obstructed.
- The drainage collection chamber should be kept below chest level to promote drainage by gravity.
- Drainage that is bright red, warm, and exceeds 100 mL per hour suggests active hemorrhage.
Nursing priorities
- Keep the drainage system upright and below the level of the patient's chest at all times.
- Monitor the water seal for tidaling and bubbling, and assess respiratory status and breath sounds.
- Measure and document drainage amount, color, and consistency, and mark the chamber level each shift.
- Keep a sterile occlusive dressing and clamp at the bedside, and never routinely clamp the tube.
- Encourage deep breathing, coughing, and repositioning to promote lung re-expansion.
Patient teaching
- Deep breathe, cough, and use incentive spirometry to help the lung re-expand.
- Avoid lying on the tubing or letting it become kinked or dependent loops form.
- Report increased shortness of breath, chest pain, or fever to the nurse.
Red flags: report now
- If the tube is dislodged from the patient, immediately cover the site with a sterile occlusive dressing taped on three sides and notify the provider.
- If the system breaks or the tube disconnects, submerge the end in sterile water to restore the water seal.
- Sudden continuous bubbling in the water seal, new subcutaneous emphysema, or respiratory distress requires immediate assessment.
- Never clamp a chest tube for an extended period or with an air leak present, as it can cause a tension pneumothorax.
References
Clinical references for this topic
