The nurse observes a constant gentle bubbling in the water-seal column of a water-seal chest drainage system. This observation should prompt the nurse to do which of the following?
Continue monitoring as usual; this is expected.
Check the connectors between the chest and drainage tubes and where the drainage tube enters the collection bottle.
Decrease the suction to –15 cm H2O and continue observing the system for changes in bubbling during the next several hours.
Drain half of the water from the water-seal chamber.
The correct answer and explanation is :
The correct answer is:
“Check the connectors between the chest and drainage tubes and where the drainage tube enters the collection bottle.”
Explanation:
A water-seal chest drainage system is used to remove air, fluid, or blood from the pleural space and to help re-expand the lung in conditions such as pneumothorax or pleural effusion. The water-seal chamber functions as a one-way valve, preventing air from flowing back into the pleural space while allowing air or fluid to exit.
Interpreting Bubbling in the Water-Seal Chamber:
- Intermittent bubbling is normal and expected when air is being expelled from the pleural space, such as in a patient with a pneumothorax that is resolving.
- Continuous bubbling in the water-seal chamber (especially a gentle but persistent bubbling) often indicates an air leak in the system. The leak can occur at any connection point, such as where the chest tube connects to the drainage tubing or within the tubing itself.
Nursing Actions:
- Check all connections in the drainage system to identify any loose fittings or disconnections.
- Assess the chest tube insertion site for signs of air leaking around the dressing or tubing.
- Temporarily clamp the chest tube (only for a few seconds) near the patient’s chest to determine if the air leak is within the patient’s pleural space or in the drainage system. If bubbling stops when clamped, the leak is inside the patient; if bubbling continues, the leak is in the system.
- Notify the healthcare provider if the leak cannot be identified or corrected.
Incorrect Answers:
- “Continue monitoring as usual” → Incorrect, because continuous bubbling is not normal and suggests an air leak.
- “Decrease the suction to –15 cm H2O” → Incorrect, because bubbling in the water-seal chamber is independent of suction settings.
- “Drain half of the water from the water-seal chamber” → Incorrect, as this could compromise the water seal and allow air to enter the pleural space.
By promptly identifying and correcting an air leak, the nurse helps ensure the effectiveness of chest tube drainage and supports lung re-expansion.