What steps should you take if breath sounds decrease on the side of a chest tube?

• A. Check tube integrity (connections, kinks, disconnection), ensure lung is expanding, obtain imaging if indicated, notify clinician.
• B. Increase suction pressure to maximum immediately.
• C. Remove the chest tube and apply a dry dressing.
• D. Ignore and continue monitoring.

Answer: (A)

When breath sounds decrease on the side with a chest tube, the priority is to identify and address issues with the chest tube system and ensure the lung can re-expand. A drop in sounds often points to tube-related problems or air leaks that prevent effective drainage and lung re-expansion, which, if left unaddressed, can worsen a pneumothorax or other complications.

The best approach is to systematically check the tube and its connections for integrity: look for kinks, disconnections, or loose connections, and confirm that all tubing is patent. If a blockage or kink is found, clearing or correcting it can restore drainage and re-expansion. After ensuring the tube is functioning, assess whether the lung on that side is expanding, as observed by chest movement and improved breath sounds following repositioning or patency restoration. Imaging may be indicated to confirm the status of the pleural space and the position of the tube, helping to detect persistent or recurrent pneumothorax or fluid collections. Finally, notify the clinician so they can decide on any further management, such as adjusting suction, repositioning the tube, or other interventions.

Elevating the importance of these steps, simply increasing suction to the maximum can cause tissue injury, worsen air leaks, or not address the underlying obstruction or disconnection. Removing the chest tube abruptly removes crucial drainage and can precipitate a dangerous reaccumulation of air or fluid. Ignoring the change is unsafe because decreased breath sounds could indicate a significant complication requiring timely action.