# 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?

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> language: en  
> subject: NCLEX-RN  
> category: PPT

## Question

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?

## Option

1. Clamp the chest tube and notify the surgeon immediately
2. Inspect all chest tube connections and the dressing for loose seals **✔ Correct answer**
3. Increase wall suction to -30 cm H2O to overcome the leak
4. Strip the chest tube tubing every 15 minutes

**Correct answer: 2**

## 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.

## In-depth explanation

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.

## Clinical scenario

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.

## Key concepts

- **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.

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