The nurse is handling a client with a chest tube. Suddenly, chest drainage system is accidentally disconnected. What is most appropriate action for nurse to take?

Correct Answer: C. Place the end of the chest tube in a container of normal sterile saline.

If a chest drainage system is disconnected, the nurse can place the end of the chest tube in a container of normal sterile saline to prevent air from entering the chest tube, thereby preventing negative respiratory pressure. A chest tube drainage system disconnecting from the chest tube inside the patient is an emergency. Immediately place the end of the chest tube in sterile water or NS. The two ends will need to be swabbed with alcohol and reconnected. Bleeding may occur after insertion of the chest tube.

• Option A: The nurse should tape the chest tube securely to prevent it from being disconnected, rather than taping it after it has been disconnected. Keep the system closed and below chest level. Make sure all connections are taped and the chest tube is secured to the chest wall.
• Option B: The nurse should not clamp the chest tube because doing so increases the risk of tension pneumothorax. Never clamp a chest tube without a doctor’s order or valid reason. The tube must remain unobscured and unclamped to drain air or fluid from the pleural space. There are a few exceptions where a chest tube may be clamped.
• Option D: The nurse should apply an occlusive dressing if the chest tube is pulled out and not if the system is disconnected. Dress the site with a dry occlusive dressing and discard the chest tube and drainage device in the hazardous waste bag. Obtain a post-removal chest X-ray if the physician has ordered it or facility protocol requires it.