George, who has undergone thoracic surgery has a chest tube connected to a water-seal drainage system attached to suction. Presence of excessive bubbling is identified in the water-seal chamber, the nurse should:
A. “Strip” the chest tube catheter
B. Check the system for air leaks
C. Recognize the system is functioning correctly
D. Decrease the amount of suction pressure
Correct Answer: B. Check the system for air leaks
Excessive bubbling indicates an air leak which must be eliminated to permit lung expansion. Know the location of air leak (patient- or system-centered) by clamping thoracic catheter just distal to exit from the chest. If bubbling stops when the catheter is clamped at the insertion site, leak is patient-centered (at insertion site or within the patient).
Option A: Stripping the chest tube has not shown to have clinical benefits. Stripping may cause negative pressure to burst up to 20 times the routine suction pressure applied. This may cause tissue injury. Stripping is usually uncomfortable for the patient because of the change in intrathoracic pressure, which may induce coughing or chest discomfort. Vigorous stripping can create very high intrathoracic suction pressure, which can be injurious (invagination of tissue into catheter eyelets, collapse of tissues around the catheter, and bleeding from rupture of small blood vessels).
Option C: The presence of excessive bubbling is not a normal finding. Observe for abnormal and continuous water-seal chamber bubbling. With suction applied, this indicates a persistent air leak that may be from a large pneumothorax at the chest insertion site (patient-centered) or chest drainage unit (system-centered).
Option D: Decreasing the amount of suction pressure without any appropriate orders may cause the system to be ineffective. Check suction control chamber for a correct amount of suction (determined by water level, wall or table regulator at correct setting. Water in a sealed chamber serves as a barrier that prevents atmospheric air from entering the pleural space should the suction source be disconnected and aids in evaluating whether the chest drainage system is functioning appropriately.