What is the first action if the chest tube becomes disconnected from the drainage system?

• A. Clamp the tube
• B. Immediately seal the insertion site with adhesive tape
• C. Keep the chest tube end in sterile water/seal; reconnect system or place the end in a new sterile bottle to maintain seal
• D. Remove the chest tube immediately

Answer: (C)

When a chest tube becomes disconnected, the priority is to keep air from leaking into the pleural space. Maintaining a closed water-seal system is essential to prevent pneumothorax or even tension pneumothorax. Placing the exposed tube end into sterile water or saline creates a temporary water seal, so air can escape through the drainage bottle instead of entering the chest. Reconnecting the tube to the drainage system as soon as possible completes the seal and restores the intended drainage.

Removing the tube would remove the drainage pathway and risk a rapid pneumothorax. Clamping the tube can trap air and potentially cause dangerous pressure buildup. Simply taping the insertion site does not preserve the necessary water seal, so it’s not the appropriate first action.