One of the scariest devices a therapist runs into in an ICU is the chest drain. It is connected through a long, large bore tube to a patient’s chest. The thought of carrying around a device filled with a patient’s blood unnerves some individuals. Show
It is not uncommon for a physician to write “patient may be on water seal for therapy.” If a therapist receives this order, they will need to be competent with moving their patient’s chest drain from wall suction to water seal and back again. Wall Suction vs. Water SealA chest drain on “wall suction” means the patient’s chest drain is attached to the vacuum regulator (the device attached to the wall that controls the suction pressure). A chest drain on “water seal” means the chest drain is not attached to the vacuum regulator.  Bubbling in the Suction Control Chamber is NormalPeople have been draining substances from the chest cavity for thousands of years,1 but it was not until after the Korean war when it became a standard practice in hospitals.2 In earlier days, chest drains did not have a suction control chamber/bottle and if an individual was to accidently increase the wall suction pressure, portions of lung tissue could evacuate through the chest tube. Nowadays, the suction pressure is controlled by the water level in the suction control chamber (in “wet” suction models). Turning the vacuum regulator pressure to its maximum level will only increase the bubbling in the suction control chamber and will not negatively impact the lungs. Empirically and in most nursing literature, it is common practice for nursing staff to turn up the vacuum regulator dial until continual, gentle bubbling occurs.3 Atrium, a maker of chest drainage systems, states that the vacuum regulator should be set at -80 mmHg pressure.4 If the suction pressure is set too high the water evaporates quicker from the drainage system and the nursing staff will have to refill it. If the suction pressure is too low, no bubbling will occur. The patient will have subtherapeutic suction pressure, which can possibly prevent the fluid or air from evacuating from the pleural cavity. Bubbling in the Water Seal Chamber May Mean an Air LeakRight next to the suction control chamber is the water seal chamber. The water seal chamber is the one-way valve that allows air to leave the pleural space, as with a pneumothorax. If removing excess air is the goal of the chest drain then the water seal chamber may bubble inconsistently, mainly on inspiration, as the air leaves the chest. If the water seal is continuously bubbling, you should suspect an air leak. Think of the lungs as wrapped in plastic. An air leak occurs when there is a hole in the plastic wrap allowing air to escape from the lung tissue into to the pleural cavity. Holes can commonly be caused by trauma or surgery. In summary, in “wet” suction drains, whether evacuating fluid or air, the only chamber that should be constantly bubbling is the suction control chamber when it is attached to the vacuum regulator. Greg Adams, PT, MS, CCS, CEPGreg has been very involved in cardiopulmonary physical therapy since 1992. In addition to his work in multiple teaching hospitals, including Temple University Hospital, Albert Einstein Hospital (Philadelphia), and the University of Maryland Medical Center, Greg has taught at conferences and for physical and occupational therapy programs. Greg has taught over 100 "Bells & Whistles"(SM) and Telemetry Courses internationally since 2001. Chest tube practice questions for the NCLEX exam. Chest tubes are used in the clinical setting to help drain fluid or air from the pleural space of the lungs or after cardiac surgery to help prevent fluid from compressing the heart (which are mediastinal chest tubes). The nurse is responsible for monitoring and maintaining the chest tube drainage system. This includes recording drainage, monitoring for air leaks or kinks, assessing suction settings, monitoring patient’s respiratory status, and assisting the physician with removal of the chest tube. After you’re done taking this quiz, don’t forget to take our other free NCLEX quizzes. Lecture on Chest Tube CareChest Tube NCLEX QuestionsThis quiz will test your knowledge on how to care for a chest tube as a nurse in preparation for the NCLEX exam.
(NOTE: When you hit submit, it will refresh this same page. Scroll down to see your results.) 1. You are providing care to a patient with a chest tube. On assessment of the drainage system, you note continuous bubbling in the water seal chamber and oscillation. Which of the following is the CORRECT nursing intervention for this type of finding? A. Reposition the patient because the tubing is kinked. B. Continue to monitor the drainage system. C. Increase the suction to the drainage system until the bubbling stops. D. Check the drainage system for an air leak. 2. A patient is receiving positive pressure mechanical ventilation and has a chest tube. When assessing the water seal chamber what do you expect to find? A. The water in the chamber will increase during inspiration and decrease during expiration. B. There will be continuous bubbling noted in the chamber. C. The water in the chamber will decrease during inspiration and increase during expiration. D. The water in the chamber will not move. 3. What type of chest tube system does this statement describe? This chest drainage system has no water column to control suction but uses a suction monitor bellow that balances the wall suction and you can adjust water suction pressure using the rotary suction dial on the side of the system. It allows for higher suction pressure levels, has no bubbling sounds, and water does not evaporate from it as with other systems. A. Mediastinal chest tube system B. Dry suction chest tube system C. Wet suction chest tube system D. Dry-Wet suction chest tube system 4. The patient in room 2569 calls on the call light to tell you something is wrong with his chest tube. When you arrive to the room you note that the drainage system has fallen on its side and is leaking drainage onto the floor from a crack in the system. What is your next PRIORITY? A. Place the patient in supine position and clamp the tubing. B. Notify the physician immediately. C. Disconnect the drainage system and get a new one. D. Disconnect the tubing from the drainage system and insert the tubing 1 inch into a bottle of sterile water and obtain a new system. 5. You’re assessing a patient who is post-opt from a chest tube insertion. On assessment, you note there is 50 cc of serosanguinous fluid in the drainage chamber, fluctuation of water in the water seal chamber when the patient breathes in and out, and bubbling in the suction control chamber. Which of the following is the most appropriate nursing intervention? A. Document your findings as normal. B. Assess for an air leak due to bubbling noted in the suction chamber. C. Notify the physician about the drainage. D. Milk the tubing to ensure patency of the tubes. 6. A patient is recovering from a pneumothorax and has a chest tube present. Which of the following is an appropriate finding when assessing the chest tube drainage system? A. Intermittent bubbling may be noted in the water seal chamber. B. 200 cc of drainage per hour is expected during recovery of a pneumothorax. C. The chest tube is positioned at the patient’s chest level to facilitate drainage. D. All of these options are appropriate findings. 7. While helping a patient with a chest tube reposition in the bed, the chest tube becomes dislodged. What is your immediate nursing intervention? A. Stay with the patient and monitor their vital signs while another nurse notifies the physician. B. Place a sterile dressing over the site and tape it on three sides and notify the physician. C. Attempt to re-insert the tube. D. Keep the site open to air and notify the physician. 8. A patient is about to have their chest tube removed by the physician. As the nurse assisting with the removal, which of the following actions will you perform? Select-all-that-apply: A. Educate the patient how to take a deep breath out and inhale rapidly while the tube in being removed. B. Gather supplies needed which will include petroleum gauze dressing per physician preference. C. Place the patient in Semi-Fowler’s position. D. Have the patient take a deep breath, exhale, and bear down during removal of the tube. E. Pre-medicate prior to removal as ordered by the physician. F. Place the patient is prone position after removal. 9. A patient with a chest tube has no fluctuation of water in the water seal chamber. What could be the cause of this? A. This is an expected finding. B. The lung may have re-expanded or there is a kink in the system. C. The system is broken and needs to be replaced. D. There is an air leak in the tubing. Answer Key 1. D Don’t forget to tell your friends about this quiz by sharing it your Facebook, Twitter, and other social media. You can also take more fun nursing quizzes. *Disclaimer: While we do our best to provide students with accurate and in-depth study quizzes, this quiz/test is for educational and entertainment purposes only. Please refer to the latest NCLEX review books for the latest updates in nursing. This quiz is copyright RegisteredNurseRn.com. Please do not copy this quiz directly; however, please feel free to share a link to this page with students, friends, and others. What is indicated by continuous bubbling in the water seal chamber with no bubbles noted in the suction control chamber of the drainage system?Continuous bubbling of this chamber indicates large air leak between the drain and the patient.
What does continuous bubbling in the water seal chamber indicate?Bubbling in the water seal chamber indicates an air leak. Air leak management remains the main problem in the discussion of the pneumothorax.
Which action would the nurse take when finding continuous bubbling in a water seal chamber of a patient with a chest tube?Continuous bubbling within the water seal chamber indicates the presence of an air leak and this means that the connection is not taped securely enough. The nurse would find the location of the air leak and intervene as appropriate.
When excessive bubbling is identified in the water seal chamber the nurse should?Assessing for an air leak: Clamp off suction for one minute. An air leak is present if there is constant bubbling in the water-seal chamber. An air leak alerts the nurse that he or she must assess for the location of the leak by checking the connections from the chest drainage unit to the insertion site.
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What is indicated by continuous bubbling in the water seal chamber with no bubbles noted in the suction control chamber of the drainage system quizlet?
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