Respiratory Question #34


The nurse is caring for a client who has a chest tube following cardiac surgery and observes a dramatic decrease in chest tube drainage from the first hour to second hour after surgery. Evaluation of the chest tube system indicates which problem?


  1. The lungs are not at risk and are fully inflated.
    • Rationale:
  2. The client is recovering without further drainage.
    • Rationale:
  3. There may be tube obstruction due to drainage clot.
    • Rationale:
  4. Tension pneumothorax is pending, so call the health care provider immediately.
    • Rationale:



The first hours following cardiac surgery may have chest tube drainage as high as 100 mL/hr but should begin slowing down after a few hours, not just in the second hour. Therefore, there must be an obstruction such as a clot or kink in the tubing. If a clot has formed, then the nurse must NOT milk the tubing, but may gently move the tubing and ensure it is draining down into the collection area of the system. Sometimes just maintaining tubing positioning with correct placement will aid in relieving clotted areas and assist with return to draining. If these measures do not help, then contact the HCP. Chest tube drainage decrease is not an indication of lung inflation or recovery.

Learning Outcomes

Test Taking Tip

Video Rationale