Chest drainage: air leak, disconnection and clamping

When a chest drainage system fails, the nurse's first duty is to keep air from entering the pleural space and to keep air that is in it able to leave, so continuous bubbling in the water seal is read as an air leak that is either the pleural space still venting or a break somewhere between the patient and the unit, and is traced by clamping the tubing momentarily and stepwise from the chest towards the unit while watching where the bubbling stops, with a new or worsening leak reported rather than tightened away; a tubing that disconnects from the unit is handled by putting the open end of the chest tube into sterile water so the seal is restored at once, never by clamping and waiting for a new unit; a tube that comes out of the chest is covered at once with a sterile occlusive dressing taped on three sides so that air can escape on exhalation but cannot be drawn in, while the provider is called and the patient watched for the breathlessness, tachycardia, falling saturation, absent breath sounds and tracheal shift of a tension pneumothorax; and the tube is clamped only for the moments it takes to locate a leak or change a cracked or overturned unit, or on the provider's order for a trial before removal with the patient watched throughout, and never during transport or as a routine precaution, because a clamped tube on a lung that is still leaking traps every breath's air in the chest and turns a managed pneumothorax into a tension pneumothorax at the bedside.