Chest Tube Management – RN Priorities

Chest tubes drain air (pneumothorax), blood (hemothorax), fluid (pleural effusion, empyema), or a combination from the pleural space. They are managed in acute care, critical care, and post-surgical settings. NCLEX-RN tests: water-seal drainage system components, what is normal vs. abnormal, when to clamp or NOT clamp, and emergency responses to dislodgement or disconnection. Indications: - Pneumothorax (collapsed lung) — tube placed at 2nd intercostal space, midclavicular line - Hemothorax — tube at 5th–6th intercostal space, midaxillary line - Post-cardiac/thoracic surgery drainage - Empyema (infected pleural fluid) - Large pleural effusion unresponsive to thoracentesis How it works: Tube → pleural space → underwater seal drainage system. The water seal acts as a one-way valve: air/fluid can exit pleural space but cannot re-enter. On the exam, writers often pair stable-sounding options with unstable data—notice the mismatch before you commit. If the stem names a license or role, reread that line; scope errors are classic trap answers even when the clinical topic is familiar. Run a 60-second scan: breathing work and oxygenation, perfusion and end organs, neuro baseline, likely infection sources, and devices...