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Check all connections for a leak in the system: Air leaks cause continuous bubbling in the water-seal chamber, not tidaling. Since tidaling is a normal movement with respiration, there is no indication of a leak or need to inspect connections.

Lower the drainage collector further from the chest: The drainage system should already be positioned below the level of the chest to facilitate gravity drainage. Tidaling is unrelated to the height of the system; lowering it further does not improve function and could risk disconnection or kinking.

Clamp the tubing at progressively distal points away from the patient until the tidaling stops: Clamping the chest tube is contraindicated unless specifically ordered for a short diagnostic purpose. Clamping during normal tidaling interrupts drainage, increases intrathoracic pressure, and can lead to a tension pneumothorax.

Place the tubing in sterile water to restore the water seal: This action is appropriate only if the chest tube becomes disconnected from the drainage system, not if it is removed from the client’s chest. Re-immersing the tubing in water after removal would not help because the open insertion site, not the tubing, is the concern.

Apply sterile gauze to the insertion site: After assessing the client, the nurse should cover the site with a sterile occlusive or petroleum gauze to prevent air entry into the pleural space, which can cause a pneumothorax. However, this comes after assessing the client’s respiratory condition.

Place tape around the insertion site: Taping all four sides of the dressing can trap air inside the pleural space, leading to a tension pneumothorax. The dressing should be taped on only three sides if air leakage is suspected, allowing trapped air to escape while preventing more air from entering.

Lie on his left side: Positioning on a particular side is not necessary during chest tube removal. The client is typically positioned in a semi-Fowler’s or supine position to allow comfort and easy access to the insertion site.

Use the incentive spirometer: Incentive spirometry is useful for promoting lung expansion after the procedure, not during removal. It should be resumed once the site is sealed and stable to prevent atelectasis.

Cough at regular intervals: Coughing during removal could force air into the pleural space through the open site, increasing the risk of pneumothorax. Controlled breath-holding or the Valsalva maneuver is safer and more effective.

Bubbling in the suction chamber: Gentle, continuous bubbling in the suction control chamber is an expected finding in a wet-suction system and indicates the suction source is functioning. Only excessive or violent bubbling would prompt further assessment for excessive suction or evaporation.

Banded connections between tubing sections: Secured (taped or banded) connections are appropriate and help maintain an airtight system, preventing air leaks.

Occlusive dressing over chest tube insertion site: An occlusive dressing at the insertion site is correct practice to prevent air entry and infection; it does not require intervention.