If a chest-tube obstruction is suspected from no drainage with poor tidaling, what steps should you take first?

• A. Check for kinks or dependent loops.
• B. Reposition the patient.
• C. Ensure tubing is patent.
• D. If obstruction persists after these steps, consult the clinician and do not milk.

Answer: (D)

When drainage stops and tidaling is poor, the first things to check are simple mechanical issues in the chest-tube system. Start by looking for kinks or dependent loops in the tubing, which can kink the line or pull it below chest level and block flow. Straighten the line and ensure the tube is comfortably positioned so gravity can assist drainage. Next, reposition the patient if needed, because a change in posture can alter the tubing angle and improve drainage.

Then verify the tubing is patent. This means checking all connections are secure, the tubing is not occluded by a clot or debris, and there are no clamps or blockages in the system. If after addressing these potential problems drainage is still absent and tidaling remains poor, involve the clinician for further assessment and management. Do not milk the chest tube, as milking can cause tissue injury or dislodge clots and has not been shown to reliably improve drainage.