when clamping the chest tube, make sure you only clamp the tube for a few seconds, while checking for the leak, because a risk of clamping longer is a tension pneumothorax .
If the bubbling stops, you know the air leak is either at the insertion site or in the lung itself. If bubbling continues, briefly clamp the tube just above to the first tubing connection. If bubbling stops, you know the air leak is most likely at the connection, which you can seal by reinforcing the connection.

If bubbling continues, move down the tubing. If you get all the way to the drain and still have bubbling, you know the air leak is in the chest drain itself. You will then need to switch out the chest tube drain.
If you are unable to easily stop the bubbling, notify the provider.

Next, check for titling… Titling is the up and down movement of the pressure float ball in the water seal chamber. With inhalation, the ball moves up because of the increase in negative pressure. And with exhalation, the ball moves down because of the positive pressure. If a patient is on a bipap or a vent, the titling will be the opposite and this is normal and if your patient has an air leak, you usually will not see the titling. If you don't see titling at all, the tubing could be blocked.

If there is an order for water seal, you will disconnect the wall suction from the suction port of the drain. The orange suction bellows will no longer be expanded.

If the chest tube tube drain is full or has a crack in it, you will need to change it. First, make sure you have the new chest tube drain open and ready to go before clamping and disconnecting the old chest tube drain.


To switch the drains, clamp the blue patient tube clamp and disconnect the in-line connector by pressing the clear button.

Quickly insert the tubing into the in-line connector of the new chest tube drain until you hear a click and immediately unclamp the tubing and then verify that suction is connected.

If there is an emergency and the new chest tube drainage system is not ready place the end of the chest tube tubing in about 1 inch of sterile water, while you are waiting for the new chest tube to be connected.

In the event the chest tube is dislodged from the patient’s chest, apply a sterile occlusive dressing and tape it on 3 sides to prevent increased lung tension.