A nurse is assisting a physician with the removal of a chest tube. The nurse should instruct the client to:
A. Exhale slowly
B. Stay very still
C. Inhale and exhale quickly
D. Perform the Valsalva maneuver
Correct Answer: D. Perform the Valsalva maneuver.
When the chest tube is removed, the client is asked to perform the Valsalva maneuver (take a deep breath, exhale, and bear down). The tube is quickly withdrawn, and an airtight dressing is taped in place. An alternative instruction is to ask the client to take a deep breath and hold the breath while the tube is removed.
Option A: The removal of the chest tube is usually performed quickly and without sedation. The doctor will give specific instructions on how to breathe when the tube is removed. In most cases, the chest tube will be removed as the client is holding his breath. This ensures extra air doesn’t get into the lungs.
Option B: Digital drainage systems have the advantage of accurately measuring the presence of air leak and thereby eradicating interobserver variability. These devices are gaining increasing popularity and are the subject of ongoing research on tube thoracostomy management. Additionally, they may play a useful role in younger pediatric patients who are unable to perform forceful expiratory maneuvers or cough on demand; however, this possibility has not yet been well studied.
Option C: No air leak should be present—that is, no bubbling should be seen in the air-leak chamber during forced expiratory maneuvers (eg, Valsalva maneuver) or cough. The swing in the fluid level in the tube in the underwater seal bottle should be minimal, relating to the normal negative pressures in the chest during the phases of respiration.
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