A 55-year-old patient with a chest tube for pneumothorax suddenly pulls out the drainage system while repositioning in bed. What should be the priority nursing action?

Appeared in: NORCET 9 Mains - 2025

Explanation

The patient has pulled the chest tube completely out, creating an open chest wound.
This allows air to rush into the pleural space, which can cause a tension pneumothorax, a life-threatening emergency.
The immediate priority is to seal the wound to prevent more air from entering.
Applying a sterile, occlusive dressing (ideally taped on three sides) creates a one-way valve, allowing trapped air to escape but stopping outside air from getting in.

Option A: The chest tube is no longer in the pleural space, so applying suction to the system is futile and does not address the open wound.
Option C: This action is for when the chest tube disconnects from the drainage unit, not when the tube is pulled out of the patient's body.
Option D: There is no tube left in the patient to clamp. Even if there were, clamping is dangerous as it can trap air in the pleural space, causing a tension pneumothorax.

Visual 1: Diagram - Application of a three-sided occlusive dressing. The diagram should show a sterile dressing taped on the top and two sides, with the bottom edge left untaped to allow air to escape during exhalation.
Visual 2: Flowchart - Differentiating chest tube emergencies. The flowchart should have two main branches: 'Tube disconnected from unit' leading to 'Place end in sterile water', and 'Tube pulled out of chest' leading to 'Apply occlusive dressing'.

Clinical Relevance

Nursing practice connection: Safe nursing care depends on performing Management of Chest Tube Complications in the correct sequence, documenting the action clearly, and monitoring for the expected response.
Recognizing and acting immediately in a chest tube emergency is a critical nursing skill that can save a patient's life.
The key is to differentiate between the tube being disconnected from the system versus being dislodged from the patient, as the priority interventions are completely different.
What if? If the patient had only disconnected the tube from the drainage unit (but the tube was still in their chest), the priority would be to place the end of the tube in sterile water, not apply a dressing to the chest wall.

How to Approach the Question

First, read the scenario carefully to identify the exact problem. The key phrase is 'pulls out the drainage system,' which implies the tube is out of the patient.
Next, consider the immediate life threat. An open hole in the chest wall leads to air entering the pleural space, causing lung collapse and potentially a tension pneumothorax. This is a 'Breathing' problem in the ABCs.
Evaluate each option based on its ability to solve this immediate problem.
Option B directly addresses the open wound by sealing it. This is the most logical first step.
Eliminate the other options by recognizing when they would be appropriate. Placing the tube in water is for a system disconnection. Clamping and suction are irrelevant or dangerous in this specific situation.

Concept Tested & Keywords

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