NU263CL Unit 7 Chest Drainage Skills Reflection Example

My Hand Was Already on the Clamp: A Skills Reflection From a Composite Student's First Chest Drainage Check, Where Continuous Bubbling in the Water Seal Chamber Met an Instructor's Single Word, Stop

[Student Name]

Purdue University Global

NU263CL: Medical-Surgical Nursing III Clinical

Unit 7 Skills Reflection

[Instructor Name]

[Date]

The patient and setting are composite; the student checked the system under the instructor's supervision, and clamping and troubleshooting follow the unit's chest tube policy.

The Setting

[Mr. G.], composite, 61, day one after removal of the upper lobe of his right lung, had one chest tube connected to a drainage system with wet suction at [20] cm of water. My task, with my instructor beside me, was the hourly system check: drainage amount and color, the water seal, the suction and the tubing.

Moment One: Bubbling I Did Not Expect

The collection chamber held [180] mL of pink fluid since midnight. The suction chamber bubbled gently, as it should. But the water seal chamber, which I had been taught should rise and fall with breathing and bubble only occasionally, was bubbling continuously. I thought: the system is leaking.

Moment Two: The Hand on the Clamp

I reached for the clamp on the bedside to clamp the tube and stop the leak. My instructor said, "Stop." I froze with the clamp in my hand.

I was about to solve a bubbling chamber by closing the only way air could leave his chest.

Clamping a chest tube when air is leaking from the lung traps that air in the chest. Pressure builds, the lung collapses further and, in the worst case, a tension pneumothorax pushes the heart and great vessels aside. Chest tubes should not be clamped routinely, and only briefly and under specific circumstances described by policy (Durai et al., 2010).

Moment Three: Four Minutes of Coaching

My instructor explained that continuous bubbling in the water seal means air is entering the system, either from the patient's lung or from a leak in the tubing or connections. After lung surgery, a small air leak from the lung surface is common in the first days and is expected to stop on its own. She then showed me how to check the system from the patient outward: the dressing, the connection at the chest, each tubing joint and the connection to the drainage unit. All were tight. She asked Mr. G. to cough; bubbling increased with the cough, which fits an air leak from the lung. We documented the leak and told my nurse, who said the surgeon knew and expected it.

What the Bubbling Was Telling Me

After the coaching, I went back over the chambers one at a time. The collection chamber told me how much fluid was draining and what it looked like. The suction chamber's gentle bubbling told me suction was working. The water seal told me whether air was coming out of the chest: tidaling with each breath meant the tube was open and connected to the pleural space, and bubbling meant air was leaving. A leak that increases with coughing and stays steady at rest is typical of air escaping from the lung surface after surgery. A sudden new leak, or bubbling that continues even when the tube is briefly checked at the chest by an experienced nurse, points to a problem in the system.

What I Felt

Embarrassment, then relief. Holding the clamp felt like doing something; leaving the bubbling alone felt like doing nothing. That instinct, to act on anything that looks wrong, is useful in some situations and dangerous in this one.

What I Will Watch for Next Time

Besides bubbling, I will watch for the warning signs that would matter more than any chamber: sudden shortness of breath, falling saturation, new chest pain, a shifting trachea or swelling under the skin near the tube. Those signs mean the patient needs help, whatever the drainage system shows. I will also note whether the leak is getting smaller each day, since a shrinking leak is part of how the surgeon decides when the tube can come out.

Edges Named Aloud

My instructor asked me to name the edges of my role aloud: I may check and document the system, keep the unit below chest level and tubing free of loops, and report changes. I may not clamp, strip or milk the tubing, or change the suction setting, without an order and supervision (Harding et al., 2023).

A Rule in One Line

Continuous bubbling in the water seal means air is getting in; find out where from, from the patient outward, and report it; never clamp to make it stop.

Checks Before Any Future Change

Before touching any part of a chest drainage system I will ask: what is this part telling me, and what would happen if I closed it? Learning from experience works best when the lesson is turned into a rule and then tested again (Kolb, 1984).

The Checklist, Left to Its Owner

My instructor's chest tube checklist stays on the unit. I wrote my own one-line rule in my notebook instead, because I will carry it to the next unit.

References

Durai, R., Hoque, H., & Davies, T. W. (2010). Managing a chest tube and drainage system. AORN Journal, 91(2), 275-283. https://doi.org/10.1016/j.aorn.2009.09.026

Harding, M. M., Kwong, J., Hagler, D., & Reinisch, C. (2023). Lewis's medical-surgical nursing: Assessment and management of clinical problems (12th ed.). Elsevier.

Kolb, D. A. (1984). Experiential learning: Experience as the source of learning and development. Prentice Hall.