Is a water seal chest tube supposed to bubble?

Does the phrase “chest tube drainage system” make you nervous? I remember being terrified of helping with chest tubes during nursing school. I was always so worried I would break something, or hurt the patient, or accidentally pull it out!

Thankfully, chest tubes aren’t as scary as they look, as long as you know how the nursing care you need to do for them!

In this video, I’ll give you 4 things you MUST know when working with chest tubes in nursing school.

We’ll talk about:
1. What to do in an emergency (like if it comes out!)
2. The nursing care you need to do
3. What to do if you see constant bubbling in the water seal chamber (like when there’s an air leak!)
4. And when you should call the doctor

Make sure to check out the other videos in this critical care nursing series, to help you ROCK your critical care exams in nursing school.

You’ve got this!!

VIDEO TRANSCRIPT

In this video I’m going to give you 4 VITAL things you need to know about chest tubes in nursing school. You’ve gotta know these things because they will probably show up on your exam somewhere, and you definitely need to know them for clinical. Before we get started, subscribe to this channel so you don’t miss out on any other nursing school tips and resources, and let’s dive in!

So the first thing you MUST know about chest tubes in nursing school, is that there’s a difference between continuous bubbling and intermittent bubbling in the water-seal chamber. Chest tubes can be used to help get air out from around the lungs, and the water seal chamber is where the air goes when it leaves the body.  

So normally, what happens, is as air leaves the pleural space, it travels down into the chest tube, and into the water seal chamber, and causes a little bit of bubbling in the water seal chamber. This is intermittent bubbling, and that’s totally fine. It just means the chest tube is doing its job and it’s getting air out of that pleural space.  

However! If there is continuous bubbling in the water seal chamber, that indicates there’s an air leak somewhere, because the water seal chamber will be bubbling continuously, meaning that air is constantly passing through. Which is not normal for when air is just trying to get out of the lungs.  

So remember: intermittent bubbling is normal, but continuous bubbling indicates an air leak.  

Now, the second thing you MUST know when taking care of chest tubes, is you MUST keep it lower than the chest. This allows it to drain properly and help maintain the proper pressures. I always like to equate it to catheters, it’s the same thing. Always keep them lower than the level of the patient, because that will allow it all to drain properly.  

I remember my first day at clinical on an ICU floor, and I was so nervous to help with the patient’s chest tube. And you know how when you’re nervous you forget just about everything? Does that happen to you too? That’s what happened to me sometimes in nursing school, my mind would just go blank. So thankfully, I had a great nurse that walked me through how to do it all, and she reminded me to keep it below the level of the patient’s chest. I was super careful with it, tip-toeing around as I moved it to where she wanted it. That was really scary, it’s always really scary when you do new things, even something as seemingly minor as moving a chest tube. It can be down-right terrifying in nursing school. I cannot be the only one who feels that way, so if you’re with me and totally get it, let me know in the comments. I’m telling you, I can’t be the only one who feels this way!  

Now the 3rd thing you absolutely HAVE to know when learning about chest tubes in nursing school, is when to call the doctor. Now, of course, this isn’t an exhaustive list, so use your awesome critical thinking skills, and always check the policies at your facility, but here are some times when you would want to contact the doctor:  

If the drainage suddenly increases, changes in color to bright red, if there’s new drainage on the dressing, or if the output is greater than 70 to 100 mL/hr. If there’s an air leak in the system, so like we talk about before, if you see continuous bubbling in the water seal chamber. Or if the patient has a change in breathing pattern, change in mental status, or if the patient’s is having symptoms of shock. Those are all times when you would need to contact the doctor.  

Keep all of those things in mind as you take your nursing school exams, because sometimes they’ll give you a question about what your “priority nursing action” would be, and there are times when there’s not much more you can do, like if their chest tube output is greater than 100mL. So read your nursing exam questions carefully, and decide when you can do something as the nurse, and when you would NEED to call the doctor.  

Now, the 4th thing you need to know when learning about chest tubes in nursing school, is what to do in an emergency! Like, if the chest tube comes out before it’s supposed to. And this is one that nursing schools LOVE to test you on, so pay attention!  

If the chest tube comes out, you’ll need to take an occlusive dressing and put tape on THREE sides of the dressing, leaving the fourth side open and put it over the wound. Then, call for help.  

You MUST make sure air can get out of the pleural space, that’s why you need to leave one side of the occlusive dressing open. If you close all sides, it will cause a tension pneumothorax, where air gets trapped inside the pleural space, putting pressure on the blood vessels and organs. So by taping only 3 sides of the dressing, it allows air to escape and not get trapped.  

So, friend, the next time you take your nursing school exam, please remember these 4 key points about chest tubes. Trust me, they WILL show up on your exams eventually because nursing instructors LOVE to test you on this stuff! So if this video helped you out, write LOVE in the comments below, and make sure you’re subscribed to this channel.  

Now, I’ve got another awesome critical care video for you coming up next, so stick around to check it out, to help you keep rocking nursing school. And go become the nurse that God created only YOU to be. I’ll see you over there! 

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