Med-Surg- From Kahn Academy

A patient recovering from a lobectomy has a chest tube attached to a water-seal drainage system. The healthcare provider notices the fluid in the water-seal column has stopped fluctuating. Which of the following would explain why the fluctuations have stopped?

Select all that apply:

  1. The lung has begun to collapse
  2. Positive interplueral pressure has increased
  3. The lung has fully expanded
  4. There may be fibrin clots in the tubing
  5. The drainage system has a leak in it

Answer: 3 and 5

The fluctuation in the water seal (tidaling) occurs as intrapleural pressure changes during inspiration and expiration. There should be patency between the intrapleural space and the chest tube system, so a blockage in the system may cause the tidaling to stop. Gradual reduction of the tidaling is expected as the lung re-expands, and will eventually stop when the lung has re-expanded.


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