Saunders Respiratory Practice

What should the nurse do immediately when a chest tube becomes disconnected?

1. Call the physician

2. Put the open end under sterile water

3. Cover the end with a sterile dressing

4. Clamp the chest tube

The correct answer is: Put the open end under sterile water

When a chest tube becomes disconnected, the immediate and correct action is to put the open end under sterile water. This technique is known as creating a water seal, which prevents air from entering the pleural space, thereby reducing the risk of a tension pneumothorax. If the tube is disconnected from the drainage system, allowing the end of the tube to submerge in sterile water creates a barrier that can help maintain negative pressure. If air enters the pleural space due to the disconnection, it could lead to respiratory distress and other complications. By placing the open end of the tube under sterile water, the nurse effectively safeguards the patient’s airway and pleural integrity while preparing for further interventions, including notifying the physician or securing the disconnection properly. In this critical situation, while covering the end with a sterile dressing or clamping the tube may seem logical, these actions do not provide the immediate protective measure that creating a water seal does. Covering the end may not prevent air entry into the pleural space, and clamping the tube can lead to complications such as build-up of pleural pressure or tension pneumothorax. Thus, establishing a water seal is the priority to ensure patient safety.