6.4 Troubleshooting Problems and Complications
Several potential problems and complications can occur when managing a client with a chest tube drainage system. Table 6.4 outlines potential problems and complications, cues to detect a problem is occurring, and associated nursing interventions.
Table 6.4 Potential Problems, Complications, Cues, and Related Interventions[1],[2]
| Problems/Complications | Cues and Interventions |
|---|---|
| Respiratory Distress |
This is a priority concern for a patient with a chest tube drainage system and can be caused by a variety of conditions. Signs and symptoms may include oxygen saturation level less than 90%, decreased breath sounds from baseline, asymmetric chest movements, hypotension, tachycardia or bradycardia, subcutaneous emphysema around insertion site or neck, tracheal deviation, or patient complaints of chest pain or increased dyspnea.
|
| Air Leak |
An air leak may be indicated by continuous or intermittent bubbling in the water seal chamber or audible air leaking from the patient’s chest. To determine the source of the leak (i.e., the patient, the tubing, or the drainage device), momentarily clamp the chest tube:
|
| Dislodged Chest Tube From the Patient |
Dislodgement of the chest tube from the insertion site in the patient’s chest is an emergent situation, and agency policy must be followed. In general, the following actions may be performed:
|
| Accidental Disconnection of Tubing or the Drainage System Cracks |
Call for assistance in replacing the drainage system and notifying the provider. Momentarily clamp the tube close to the insertion site on the patient’s chest wall or alternatively place the distal end of the chest tube in a bottle of sterile water. |
| Bleeding at the Insertion Site |
Bleeding may occur after insertion of the chest tube. Apply pressure to the site, reinforce the dressing, and notify the provider. |
| Subcutaneous Emphysema |
Subcutaneous emphysema can indicate a worsening air leak in the chest cavity or a tension pneumothorax as thoracic pressure increases and forces air from the chest cavity out of the tube insertion site and into the tissues. The provider should be notified if subcutaneous emphysema is new or worsening. It may be helpful to mark the area of subcutaneous emphysema to determine if it is extending and worsening. |
| Drainage Stops |
If drainage suddenly stops in the first 24 hours after chest tube insertion, the tubing may be clogged by a blood clot or by a fluid blockage in a dependent loop:
|
| Sudden Increase in Bright Red Drainage |
An increase of bright red drainage of more than 200 mL/hour may indicate vascular injury that requires surgical repair[3]:
|
| Drainage Unit Tips Over |
|
| Overfilled Water Seal or Suction Control Chamber |
|
| Suction Control Chamber Not Bubbling or Bubbling Too Much |
The suction control chamber should have gentle bubbling. Vigorous bubbling can indicate wall suction is set too high and can cause faster evaporation, requiring water to be added.
|
- Chest tube and drainage system monitoring and care. (2022). Lippincott procedures. http://procedures.lww.com ↵
- This work is a derivative of Clinical Procedures for Safer Patient Care by British Columbia Institute of Technology and is licensed under CC BY 4.0 ↵
- Merkle, A. (2022). Care of a chest tube. StatPearls. https://www.statpearls.com/ArticleLibrary/viewarticle/41781 ↵