Remember the DOPE Mnemonic for assessing air leaks:

D: Dislodgement

O: Obstruction

P: Pneumothorax

E: Equipment Failure

Assessment

When doing your assessment,

Assess the color of drainage in the drainage tubing and collection chamber. Know that old drainage in the collection chamber may inaccurately reflect current drainage as shown in the tubing. At regular intervals (at least every 8 hours), document the amount of drainage and its characteristics on the clinical flow sheet. Report sudden fluctuations or changes in chest-tube output (especially a sudden increase from previous drainage) or changes in character (especially bright red blood or free-flowing red drainage, which could indicate hemorrhage). Frequent position changes, coughing, and deep breathing help reexpand the lung and promote fluid drainage.

Don’t milk, strip, or clamp the tube:

Avoid aggressive chest-tube manipulation, including stripping or milking, because this can generate extreme negative pressures in the tube and does little to maintain chest-tube patency. If you see visible clots, squeeze hand-over-hand along the tubing and release the tubing between squeezes to help move the clots into the CDU.

As a rule, avoid clamping a chest tube. Clamping prevents the escape of air or fluid, increasing the risk of tension pneumothorax. You can clamp the tube momentarily to replace the CDU if you need to locate the source of an air leak, but never clamp it when transporting the patient or for an extended period, unless ordered by the physician (such as for a trial before chest-tube removal).

In the event of chest-tube disconnection with contamination, you may submerge the tube 1″ to 2″ (2 to 4 cm) below the surface of a 250-mL bottle of sterile water or saline solution until a new CDU is set up. This establishes a water seal, allows air to escape, and prevents air reentry.

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