What signs indicate a chest tube is not functioning properly, and what steps should be taken?

• A. No drainage or persistent air leak; kinked or dislodged tube; assess system, reposition or replace, obtain imaging if needed.
• B. Continuous drainage; reposition and observe.
• C. Increased pain only; administer analgesics.
• D. Adequate drainage with no air; remove tube.

Answer: (A)

A chest tube is not functioning properly when drainage stops or becomes inconsistent and when there isn’t a seal for air to escape, which often shows up as a persistent air leak, and when the tube itself is kinked or dislodged. These signs mean the pleural space isn’t adequately being drained and the lung can’t re-expand as intended.

To address it, systematically inspect the entire drainage system: check all connections for leaks or disconnections, make sure the tubing isn’t kinked or clamped, and verify suction (if used) is active. If you find a kink or the tube is partially or fully dislodged, reposition or replace the chest tube and obtain imaging to confirm proper placement and lung re-expansion. If the tube is dislodged, cover the site with a sterile occlusive dressing taped on three sides to allow air to escape while preventing entry, and notify the team. Then continue to monitor the patient closely and recheck the drainage system and imaging as needed.