Chest Tubes + Pneumothorax Nursing: Bubbling, Tidaling, Tube Out (NCLEX)

Chest tubes and pneumothorax nursing for NCLEX and med-surg: what a pneumothorax is, the 4 types, the signs, tension pneumothorax (the TRAP signs and what you do), the chest drainage system chamber by chamber (collection, water seal, suction control, wet vs dry), what tidaling and bubbling mean, the every-shift SCUBA check, what to do if the tube comes out or disconnects, and 4 practice questions. Question 4 is the tube that falls out. QUICK ANSWERS • What are the 3 chambers of a chest tube drainage system? Collection (catches and measures the drainage), water seal (sterile water to the 2 cm line: a one-way valve that lets air out but not back in), and suction control (only if suction is ordered, usually -20 cm H2O; wet systems use a water column, dry systems use a dial). Think: catch, seal, pull. • What is tidaling? The water in the water seal rises when the patient breathes in and falls when they breathe out (reversed on a ventilator). It means the tube is open. If it stops, the lung may have re-expanded, or the tubing is kinked, clotted or has a fluid-filled loop: check the tubing first. • Is bubbling in the water seal normal? With a pneumothorax, bubbling when the patient breathes out or coughs is expected (air leaving the chest) and should fade as the lung heals. Continuous bubbling means an air leak: check the site, then every connection, then the unit, and call if you can't fix it. If the tube drains fluid, bubbling in the water seal is not expected. Gentle, steady bubbling in a wet suction chamber is normal. • What are the signs of a tension pneumothorax? TRAP: Trachea shifts away from the affected side (a late sign), Rapid heart rate, Absent breath sounds on one side, Pressure drops (low blood pressure). Neck veins may bulge. Call for help, stay, give oxygen and prepare for needle decompression. Don't wait for an X-ray. • What do you do if a chest tube comes out? Cover the site right away with a sterile dressing (many policies: an occlusive dressing taped on three sides), call for help without leaving, and watch for tension pneumothorax. • What do you do if a chest tube disconnects from the drainage system? Put the end of the tube in sterile water, 2 to 4 cm deep, to make a water seal, then set up a new system and call (some policies allow a quick reconnect if the end stayed clean). Out of the chest? Cover the chest. Off the box? Into the water. • Should you clamp or strip a chest tube? Not routinely. Don't clamp for transport (unhook the suction; the water seal keeps working) and don't strip the tubing. Brief clamping is used only when your policy allows it. Comment your score out of 4, and the chest tube rule that finally clicked. PRACTICE NCLEX QUESTIONS IN NURSELINGO NurseLingo on the App Store: https://apps.apple.com/us/app/nurseli... Free NCLEX games: https://nurselingo.app/arcade Website: https://nurselingo.app MORE NCLEX REVIEW Head to Toe Assessment: Full Check-Off in 11 Min (lung sounds):    • Head to Toe Assessment Nursing | Full Chec...   Vital Signs: Full Check-Off in 9 Min:    • Vital Signs Nursing | Full Check-Off in 9 ...   Types of Shock (tension pneumothorax is obstructive shock):    • Types of Shock Made Easy: 4 Types, 1 Patte...   ABGs: Tic-Tac-Toe Method, 5 Real Patients:    • ABGs Made Easy for Nursing Students | Tic-...   NCLEX Prioritization: Who Do You See First?:    • NCLEX Prioritization: Who Do You See First...   CHAPTERS 0:00 Intro 0:24 What a pneumothorax is 0:54 Types 1:27 Signs 2:02 Tension pneumothorax 3:37 Diagnosis + treatment 4:18 The chest tube 4:41 The 3 chambers 5:51 Tidaling 6:18 Bubbling 7:46 Nursing care: SCUBA 10:02 Tube out or disconnected 10:54 Final question 11:31 Recap SOURCES OpenStax Medical-Surgical Nursing 11.6 Pneumothorax: https://openstax.org/books/medical-su... OpenStax Clinical Nursing Skills 18.4 (chest tube insertion): https://openstax.org/books/clinical-n... Open RN Nursing Advanced Skills, Chapter 6 Chest Tube Drainage Systems: https://wtcs.pressbooks.pub/nursingad... MSD Manual, Pneumothorax: https://www.msdmanuals.com/profession... American Nurse Today, Chest-tube care: https://www.myamericannurse.com/chest... All 4 questions are from the NurseLingo question bank. TRAP, SCUBA and "Out = cover, Off = water" are NurseLingo memory tricks. For education only. Clamping, milking, dressing type and drainage limits vary by facility; always follow your orders, policies and your unit's drainage system instructions. NurseLingo is not affiliated with NCSBN. #NCLEX #NursingStudent #ChestTubes