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NCLEX Review: Chest Tubes

    * Pneumothorax – collection of air in the pleura space

    * Hemothorax – an accumulation of blood and fluid in the pleural cavity between the parietal and visceral pleurae,   usually as the result of trauma

A chest tube is basically a catheter inserted through the thorax to remove air and fluids from the pleural space and to reestablish a normal intrapleural pressures.


  • Bubbling in the water seal chamber is normal and is caused by air passing out of the pleural space into the fluid chamber.  
  • Intermittent bubbling is normal.   It indicates that the system is accomplishing a purpose which is to remove air from the pleural space. 
  • Continuous bubbling during inspiration and expiration indicates that there is an air leak.

Types of Chest Tube Systems:

Pleur-Evac chest drainage system

A One-piece molded plastic unit that duplicates the three-chambered system

  • There must be bubbles flowing in the suction control portion of the unit to provide suction to the patient

Pleur-Evac Set Up

  • Fill water seal chamber
  • Fill suction control chamber
  • Attach tube to suction source
  • Tape all the connections
  • Provide sterile tube for connection to patient


Some Problems that can be encountered with the test tube.

Air leak

♣ Continuous bubbling is seen in water-seal bottle/chamber, indicating that leak is between patient and water seal

  • Locate leak
  • Tighten loose connection between patient and water seal
  • Loose connections cause air to enter system.
  • Leaks are corrected when constant bubbling stops
  • Problem:  Bubbling continues, indicating that air leak has not been corrected
  • Cross-clamp chest tube close to patient’s chest, if bubbling stops, air leak is inside the patient’s thorax or at chest tube insertion site
  • Unclamp tube and notify physician immediately!
  • Reinforce chest dressing


     *  Remember that leaving chest tube clamped caused a tension pneumothorax and mediastinal shift

Bubbling continues, indicating that leak is not in the patient’s chest or at the insertion site

  • Gradually move clamps down drainage tubing away from patient and toward suction-control chamber, moving one clamp at a time
  • When bubbling stops, leak is in section of tubing or connection distal to the clamp
  • Replace tubing or secure connection and release clamp
  •  Problem:  Bubbling continues, indicating that leak is not in tubing
  • Leak is in drainage system
  • Change drainage system


Problem:  Tension pneumothorax is present

(1)        Problems:  Severe respiratory distress or chest pain

Determine that chest tubes are not clamped, kinked, or occluded. Locate leak

Obstructed chest tubes trap air in intrapleural space when air leak originates within patient

 Problem:  Absence of breath sounds on affected side

  • Notify physician immediately



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