A nurse is assisting a provider with the removal of a chest tube. Which of the following should the nurse instruct the client to do?

Tidaling, or the rising and falling of fluid in the water-seal chamber with the patient’s respirations, is a normal finding in a closed chest tube drainage system. It reflects pressure changes in the pleural space as the patient breathes and indicates that the system is patent and functioning properly.

Rationale for Correct Answer

1. Continue to monitor the patient: Tidaling confirms that the chest tube is maintaining negative pressure and allowing air or fluid to drain appropriately from the pleural space. As the lung re-expands, tidaling will gradually decrease and eventually stop—this is expected and not a sign of malfunction. The nurse should continue monitoring respiratory status and drainage characteristics.

Rationale for Incorrect Answers

2. Check all connections for a leak in the system: Air leaks cause continuous bubbling in the water-seal chamber, not tidaling. Since tidaling is a normal movement with respiration, there is no indication of a leak or need to inspect connections.

3. Lower the drainage collector further from the chest: The drainage system should already be positioned below the level of the chest to facilitate gravity drainage. Tidaling is unrelated to the height of the system; lowering it further does not improve function and could risk disconnection or kinking.

4. Clamp the tubing at progressively distal points away from the patient until the tidaling stops: Clamping the chest tube is contraindicated unless specifically ordered for a short diagnostic purpose. Clamping during normal tidaling interrupts drainage, increases intrathoracic pressure, and can lead to a tension pneumothorax.

Take-Home Points

• Tidaling in the water-seal chamber is a normal and expected finding that reflects changes in pleural pressure with breathing.
• Decreased or absent tidaling may indicate lung re-expansion or tube obstruction.
• Continuous bubbling, not tidaling, signals an air leak that requires investigation.
• The drainage system should remain below chest level, upright, and secure at all times.

When assessing a client with a chest tube, the nurse should recognize gentle bubbling in the suction control chamber and tidaling in the water-seal chamber as normal, expected findings. These indicate that the drainage system is functioning properly and that the pleural space pressure is being effectively managed.

Rationale for Correct Answers

2. Gentle constant bubbling in the suction control chamber: This is an expected finding that shows the suction source is functioning correctly. Bubbling here reflects the amount of suction being applied, not air movement from the pleural space. The bubbling should be gentle and continuous—vigorous bubbling indicates excessive suction and evaporation of water.

3. Rise and fall in the level of water in the water seal chamber with inspiration and expiration: This fluctuation, known as tidaling, indicates that pressure changes occur in the pleural space during breathing and that the chest tube is patent. As the lung re-expands, tidaling will gradually lessen and eventually stop.

Rationale for Incorrect Answers

1. Continuous bubbling in the water seal chamber: Continuous bubbling in the water seal chamber is not normal and indicates an air leak in the system or from the patient’s pleural space. The nurse should inspect all connections and notify the provider if the leak source cannot be found.

4. Exposed sutures without dressing: The insertion site should always be covered with a sterile occlusive dressing to prevent infection and air entry. Exposed sutures without a dressing indicate improper care and increase infection risk.

5. Drainage system upright at chest level: The drainage system should always be below the level of the chest to allow gravity drainage of air and fluid. Keeping it at chest level or higher can cause backflow into the pleural space, leading to lung collapse or infection.

Take-Home Points

• Gentle bubbling in the suction control chamber confirms proper suction function.
• Tidaling in the water-seal chamber shows normal pressure changes and tube patency.
• Continuous bubbling in the water-seal chamber signals an air leak that must be investigated.
• The insertion site should be covered with a sterile dressing at all times.
• The drainage system must remain below chest level to promote safe and effective drainage.