Chest Tube Management

A chest tube evacuates air or fluid from the pleural space to restore negative intrapleural pressure. The drainage system has three chambers: collection (measures output), water-seal (acts as a one-way valve — air exits but cannot re-enter), and suction control (regulates negative pressure, typically −20 cm H₂O). Tidaling — the rise and fall of fluid in the water-seal chamber with respirations — is normal and confirms the tube is patent and communicating with the pleural space. Continuous bubbling in the water-seal chamber signals an air leak; intermittent bubbling during expiration or cough is expected with a pneumothorax until the lung re-expands. You assess drainage color, amount, and rate hourly post-insertion; notify the provider if output exceeds 70–100 mL/hour of bloody drainage. Keep the system below chest level at all times. Never clamp a chest tube unless specifically ordered or when briefly changing the collection system — clamping can convert a simple pneumothorax into a tension pneumothorax. If the tube accidentally disconnects, submerge the end in sterile water (acts as an emergency water seal), not clamp it. If the tube is pulled out, cover the site immediately with petroleum gauze taped on three sides to create a flutter-valve effect.