Miss Israel has a chest tube in place for a spontaneous pneumothorax. You note that the water seal chamber is bubbling vigorously. What could cause bubbling in the water seal chamber? What should you do?
The correct answer and explanation is:
Answer:
Bubbling in the water seal chamber of a chest tube drainage system indicates the presence of air. If the bubbling is vigorous and continuous, it suggests an air leak, which could be caused by the following:
- Persistent Pneumothorax: Air is leaking from the lung into the pleural space.
- Chest Tube Disconnection or Malfunction: A loose connection in the tubing or a crack in the system can introduce air.
- Improperly Sealed Insertion Site: If the chest tube insertion site is not well-sealed, air can be drawn in.
- Faulty Drainage System: The drainage system may have a defect allowing air to enter.
What to Do:
- Assess the Patient: Check for respiratory distress, worsening symptoms, or subcutaneous emphysema.
- Check the Tubing: Inspect the entire length of the chest tube for disconnections or cracks. Reconnect or replace if necessary.
- Perform a Leak Test: Temporarily clamp the tube near the patient. If bubbling stops, the air leak is from the lung. If bubbling continues, the leak is in the tubing or system.
- Reinforce the Dressing: Ensure the chest tube insertion site is airtight using an occlusive dressing.
- Replace the Drainage System if Faulty: If the leak is in the system, replace it.
- Notify the Physician: If a persistent pneumothorax is suspected, the provider may need to adjust suction or interven