During chest tube removal, which action helps prevent air from re-entering the chest?

• A. The patient holds their breath and bears down
• B. The patient breathes normally
• C. The patient coughs repeatedly
• D. The patient breathes out slowly

Answer: (A)

During chest tube removal, you want to momentarily raise intrathoracic pressure to keep air from being sucked into the pleural space as the tube exits. Having the patient hold their breath and bear down (a Valsalva maneuver) creates that brief positive pressure, helping seal the entry and prevent air entry. Breathing normally wouldn’t provide the protective pressure during the critical moment, and coughing or exhaling slowly can disrupt the seal or even create fluctuations that draw air in. So, the action that best prevents air re-entry is holding the breath and bearing down at the moment of removal.