# A client has a left chest tube placed yesterday for a spontaneous pneumothorax. It is connected to a drainage system at -20 cm H2O wet suction. At 0800, the water-seal chamber showed tidaling with no bubbling. At 1000, after the client was helped into a chair, the nurse notes continuous bubbling in the water-seal chamber. Tidaling is present, SpO2 is 95% (96% at 0800), RR is 18/min, and the client denies new shortness of breath. A length of tubing hangs in a loop below the chair seat. Which actions should the nurse take? Select all that apply.

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> subject: Illness Management  
> category: PA

## Question

A client has a left chest tube placed yesterday for a spontaneous pneumothorax. It is connected to a drainage system at -20 cm H2O wet suction. At 0800, the water-seal chamber showed tidaling with no bubbling. At 1000, after the client was helped into a chair, the nurse notes continuous bubbling in the water-seal chamber. Tidaling is present, SpO2 is 95% (96% at 0800), RR is 18/min, and the client denies new shortness of breath. A length of tubing hangs in a loop below the chair seat. Which actions should the nurse take? Select all that apply.

1

Auscultate breath sounds and reassess the respiratory effort

2

Clamp the chest tube near the chest wall until the provider arrives

3

Arrange the tubing so it runs to the unit without a dependent loop

4

Turn off the wall suction until the bubbling in the chamber stops

5

Check each tubing connection and the dressing for a loose seal

6

Strip the tubing toward the drainage unit to clear the tubing

## Explanation

The bubbling was absent at 0800 and began right after the client moved to the chair, which points first to a system leak such as a loosened connection or dressing, so the nurse checks connections and the dressing, removes the dependent loop, and reassesses the lungs. Clamping, stripping, and turning off suction are older or reflex responses that can cause a tension pneumothorax, tissue injury, or loss of evacuation.

## In-depth explanation

Quick answer
Check the connections and dressing, remove the dependent loop, and reassess breath sounds and respiratory effort (options 5, 3, 1).

Why this is correct
The trend matters: no bubbling at 0800 and continuous bubbling right after a transfer suggests the system was disturbed, so the connections and the insertion-site dressing are the first places to look. A dependent loop lets fluid collect in the tubing and impairs drainage, so the tubing is laid out without a loop. Because a new leak can also come from the lung, the nurse reassesses breath sounds and effort; SpO2 and RR are stable, so there is time for systematic checking.

Easy analogy or mental picture
Bubbling that starts right after the furniture moved is like a garden hose that starts spraying after someone stepped on it: check the couplings before blaming the tap.

Memory hook
New bubbling after a move: check the joints, straighten the line, listen to the lungs; never clamp, strip, or shut it off.

NCLEX decision rule
When a drainage system changes after a mechanical event, inspect the system and reassess the client before any intervention that blocks drainage.

Why the other choices are wrong
Clamping near the chest wall (option 2) is tempting because it is still taught as a way to locate a leak or 'stop' air, but prolonged clamping with an ongoing air leak can cause a tension pneumothorax; brief clamping is done only when ordered. Stripping the tubing (option 6) is an older practice to keep tubes patent, but it creates very high negative pressure and can injure tissue; it is not done routinely. Turning off suction (option 4) seems to stop the bubbling, but the bubbling shows air escaping, and removing suction may let air accumulate in the pleural space.

References
1NCBI Bookshelf (StatPearls): Chest Tube ManagementChest drainage system assessment, air leak evaluation, and avoidance of routine stripping or clamping

## Clinical scenario

Scenario
A client with a chest tube for pneumothorax develops new continuous water-seal bubbling right after being moved to a chair, while remaining stable.

## Key concepts

- **Water-seal chamber** — The chamber that acts as a one-way valve, letting air leave the pleural space but not return.
- **Tidaling** — Rise and fall of water in the water-seal chamber with breathing, showing the system is patent and connected to the pleural space.
- **Air leak** — Continuous bubbling in the water-seal chamber from air entering the system, from either the client's lung or a break in the tubing or dressing.

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