A nurse caring for a client 12 hours after a right lower lobectomy notes new crepitus extending from the chest tube insertion site to the clavicle. The chest drainage system shows continuous bubbling in the air-leak chamber. Which action should the nurse take FIRST?
1Increase wall suction to -30 cm H2O to overcome the leak
2Strip the chest tube tubing every 15 minutes
3Clamp the chest tube and notify the surgeon immediately
4Inspect all chest tube connections and the dressing for loose seals✓ Correct answer
Explanation
Continuous bubbling with new subcutaneous emphysema points to an air-leak source — most often a loose connection or a tube hole that migrated above the skin. Tightening connections and reinforcing the occlusive dressing is the FIRST nursing action and frequently resolves the leak. Clamping a chest tube with a known air leak risks tension pneumothorax. Increasing suction does not fix the leak. Stripping is contraindicated because it generates dangerously high negative pressure.
Priority: assess connections first (least invasive, most often diagnostic). Never clamp a leaking chest tube — air must continue to escape. Crepitus that ascends rapidly toward the neck warrants surgeon notification AFTER initial inspection.
Postoperative day 1, right thoracotomy with 28 Fr chest tube to -20 cm H2O suction. Vital signs: BP 118/72, HR 96, RR 22, SpO2 94 percent on 2 L NC.
subcutaneous emphysema — Air trapped in subcutaneous tissue producing crepitus on palpation.
air-leak chamber — Middle chamber of a chest drainage unit; continuous bubbling indicates a persistent leak.
lobectomy — Surgical removal of one lobe of the lung.