RN Nursing · Pleural Disorders · Practice question
A chest tube system shows continuous bubbling in the water-seal chamber. Which actions are appropriate? Select all that apply.
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Milk the chest tube
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Clamp the chest tube routinely to stop bubbling
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✓
Assess for an air leak
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✓
Notify provider if unresolved after troubleshooting
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✓
Check all connections
Answer & explanation
Correct: Assess for an air leak · Notify provider if unresolved after troubleshooting · Check all connections
Continuous bubbling in the water-seal chamber of a chest drainage system indicates a persistent air leak, which may originate from the patient's pleural space or from a break in the system itself. The first nursing action is to assess for an air leak by systematically checking all tubing connections, drainage system junctions, and the insertion site to locate the source. Checking all connections is a direct component of this assessment and may resolve the issue if a loose connection is found and tightened. If troubleshooting does not resolve the continuous bubbling, the provider must be notified because a persistent pleural air leak may indicate ongoing pneumothorax or bronchopleural fistula requiring intervention. Milking or stripping the chest tube is no longer recommended practice; it generates excessive negative pressure and can damage lung tissue or dislodge clots without clinical benefit for an air leak. Clamping the chest tube routinely is contraindicated because it traps air in the pleural space and can cause tension pneumothorax, a life-threatening emergency. These two actions are therefore excluded from the correct responses.
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