Troubleshooting Chest Tubes

Troubleshooting Chest Tubes

Air Leak
Continuous bubbling in the water seal chamber suggests that there is an air leak, either in the Pt or in the drainage system. Possible causes include a disconnection or break in the drainage system, an incomplete seal around the tube at the insertion site, or an improperly inserted tube. Notify the MD, and check the Pt and system for the source of the air leak:

■ Briefly occlude the tube manually by pinching the tubing close to the chest wall. A cessation of bubbling suggests that the air leak is within the Pt at the insertion site. Notify the physician.
■ If bubbling continues, assess to see if air might be entering at the insertion site around the wound. Using both hands, apply pressure around insertion site. If bubbling stops or decreases with pressure, notify physician and discuss replacing dressing with another pressure dressing. A suture may be required around tube.
■ If neither measure decreases bubbling, the air leak may be in the tubing and/or connections. Secure and retape all connections.
■ If air leak is still present, change out drainage system.

The Chest Tube Has Become
Completely separated from the Pt.
■ Assess Pt for respiratory distress and notify physician stat.
■ Apply occlusive dressing to insertion site (taped on three sides to allow air to escape, but not enter the chest).* Partially pulled out of the insertion site, exposing the drainage opening, but the end of the chest tube still remains in the Pt.
■ Assess Pt for respiratory distress and notify physician stat.
■ Remove dressing at insertion site and wrap chest tube (covering the drainage opening) with an occlusive dressing.* *Be prepared to assist with reinsertion of new chest tube.

Chest tube has become disconnected from drainage unit
■ Do one of three things while preparing to reattach tubes: (1) Leave the tube open to air, (2) Submerge the distal end of the chest tube under 1–2 inches of sterile water or normal saline (essentially, a water seal), or (3) Attach a one-way (Heimlich) valve.
■ Clean both exposed ends with Betadine swabs for 30 seconds and let air dry for 30 seconds. Reconnect drainage system and retape with fresh waterproof tape.
■ If tube connections have been grossly contaminated (i.e., with feces, urine, etc.), a new drainage system including sterile connector must be attached. This must be done as quickly as possible to prevent respiratory distress due to possible pneumothorax.