Chest Tube: Sudden Cessation of Drainage

Scenario

You are caring for a patient with a left-sided chest tube connected to a water-seal drainage system following a pneumothorax.
Suddenly, you notice that the drainage stops, and the patient becomes dyspneic, restless, and tachycardic.

Question: What are your immediate assessment and intervention priorities?

Best Practice Answer

1. Recognize the Emergency: Sudden cessation of drainage combined with respiratory distress may indicate:

   • Obstruction or disconnection in the chest drainage system, or
   • Reaccumulation of air leading to a tension pneumothorax.
     Either situation is time-sensitive and requires immediate nursing action.

2. Assess the System from Patient to Drainage Unit:

   • Inspect tubing for kinks, dependent loops, or clots that could obstruct flow.
   • Ensure the chest tube is not clamped — clamping can trap air and create a pressure buildup.
   • Verify that the drainage system is below the patient’s chest level to maintain gravity drainage.

3. Check for Disconnection or Air Leak:

   • If the chest tube becomes disconnected from the drainage unit, immediately submerge the end in sterile water to maintain a temporary water seal.
   • This prevents air from re-entering the pleural space while awaiting reconnection or a new system.

4. Assess the Patient, Not Just the Equipment:

   • Observe respiratory effort, breath sounds, and chest symmetry.
   • Diminished or absent breath sounds on the affected side may suggest lung collapse.
   • Tracheal deviation, hypotension, and distended neck veins indicate a tension pneumothorax — a life-threatening emergency.

5. Intervene Promptly:

   • Call for immediate assistance and notify the provider or rapid response team.
   • Prepare for potential chest tube replacement or needle decompression if tension pneumothorax is suspected.
   • Administer supplemental oxygen to support oxygenation while interventions are underway.

6. Monitor and Support:

   • Continue vital sign monitoring, SpO₂ tracking, and patient reassurance.
   • Keep sterile gauze and a new drainage system ready.
   • Document findings, actions, and patient response clearly.

Real-World Application

This scenario is a classic clinical-simulation question used to assess whether candidates can differentiate equipment malfunction from patient deterioration.
The interviewer looks for rapid assessment skills, mechanical understanding of the drainage system, and recognition of tension pneumothorax risk.

This knowledge is critical for ICU, ER, step-down, and thoracic post-op nurses.

A strong candidate demonstrates:

• Calm, sequential troubleshooting
• Awareness that clamping or delays can cause catastrophic collapse
• Team communication and preparation for escalation

Tip: Say clearly in an interview —
“I’d first check for kinks or clamps, assess breath sounds, and if disconnected, place the tube in sterile water — then call the provider immediately, anticipating a possible tension pneumothorax.”
That line shows both technical knowledge and situational judgment under pressure.