A nurse is assessing a client who has a chest tube with a water seal drainage system.
Upon assessment, the nurse notes tidaling in the water seal.
Which of the following is an explanation for the tidaling?
A.
The lung has re-expanded.
B.
There is a loop of tubing below the drainage system.
C.
The system is working properly.
D.
The tubing is partially obstructed by clots.
The Correct Answer and Explanation is:
The correct answer is C. The system is working properly.
Explanation:
In a chest tube with a water seal drainage system, tidaling refers to the observable rise and fall of the water level in the water-seal chamber with each breath. This phenomenon is a normal and expected finding in the functioning of a chest tube system.
Here’s why tidaling occurs and what it signifies:
- Normal Function of the Chest Tube System:
Tidaling is an indicator that the chest tube system is functioning correctly. As the patient breathes, intrathoracic pressure changes. During inhalation, the negative pressure created in the pleural cavity causes the water level in the water-seal chamber to rise. Conversely, during exhalation, the water level drops. This fluctuation reflects the patient’s breathing pattern and the normal movement of air and fluids through the drainage system. - Indicator of Lung Expansion:
Tidaling suggests that the chest tube is allowing for the proper drainage of air, fluid, or both from the pleural space. If the lung were fully re-expanded, the tidaling might decrease or cease because the pressure in the pleural space would be normalizing, reducing the need for ongoing drainage. However, the presence of tidaling alone does not confirm full lung re-expansion but indicates that the drainage system is operational. - Assessment of the System:
If tidaling is observed, it means that the chest tube is correctly positioned, and the water-seal chamber is functioning as intended. This is a good sign that the drainage system is effectively allowing air or fluid to escape while maintaining a one-way valve mechanism to prevent air or fluid from re-entering the pleural space.
Other Options:
- A. The lung has re-expanded: If this were the case, tidaling would likely be reduced or absent. The presence of tidaling usually indicates that the lung is not fully re-expanded yet.
- B. There is a loop of tubing below the drainage system: This might cause problems such as fluid accumulation or blockages but would not typically cause tidaling. Tidaling is usually unaffected by tubing loops unless they cause significant obstruction.
- D. The tubing is partially obstructed by clots: Obstruction would likely lead to other signs, such as decreased drainage or bubbling in the water-seal chamber, rather than tidaling.
In summary, tidaling in the water-seal chamber is a normal and reassuring sign that the chest tube drainage system is functioning properly and responding to the patient’s respiratory changes.