NCLEX · Basic Care and Comfort

A client with a chest tube is being transferred between units. During transport, the chest tube drainage system accidentally tips over. What is the priority action?

Correct answer

Immediately return the drainage system to the upright position — a tipped drainage system allows fluid to block the water seal, which could create a pressure imbalance; ensure all connections are intact and the system continues to drain properly; notify the RN

  1. A Leave it tipped until arriving at the destination
  2. B Immediately return the drainage system to the upright position — a tipped drainage system allows fluid to block the water seal, which could create a pressure imbalance; ensure all connections are intact and the system continues to drain properly; notify the RN
  3. C Clamp the chest tube
  4. D Remove the chest tube

Why this is the answer

CHEST TUBE MANAGEMENT DURING TRANSPORT: DRAINAGE SYSTEM POSITIONING: Must remain upright to maintain the water seal; the water seal prevents air from entering the pleural space; SYSTEM TIPPED: Priority is to return to upright position quickly; if water seal is disrupted (water spilled), notify RN immediately — the seal must be maintained; CLAMPING CONTROVERSY: Chest tubes should NOT be routinely clamped during transport (risk: tension pneumothorax if air is entering and tube is clamped); EXCEPTIONS: Clamp briefly only if the system must be changed, or per specific physician order; DURING TRANSPORT: Keep system below chest level; prevent pulling on the tubing; have clamps available (not applied) in case system disconnects; if tube disconnects, submerge the end in sterile water to restore water seal until replacement system can be set up; PN SCOPE: Monitor the drainage system; report changes; do not independently clamp without RN/provider direction.
Source: NCLEX-PN Physiological — Chest Tube Management, Transport Considerations