What should the first action of a respiratory therapist be if they notice profuse bubbling in the water seal chamber of a chest tube drainage system?

• A. Decrease mandatory rate to 14
• B. Clamp the chest tube at the patient
• C. Monitor the patient as usual
• D. Switch to pressure controlled ventilation

Answer: (B)

If a respiratory therapist observes profuse bubbling in the water seal chamber of a chest tube drainage system, the initial action should be to clamp the chest tube at the patient. This bubbling often indicates a possible air leak in the system, which could lead to complications such as respiratory distress or a pneumothorax. By clamping the chest tube, the therapist temporarily eliminates the possibility of further air escaping from the pleural space, allowing time to assess the situation and determine the source of the leak.

It is important to understand that taking immediate action in response to unusual observations in a clinical setting is critical for patient safety. Clamping the tube allows for a more controlled assessment of the patient’s condition and the drainage system without allowing more air to enter, which could worsen the patient's respiratory status.

Monitoring the patient as usual does not address the immediate concern of the bubbling, and adjusting the mandatory rate or switching to pressure-controlled ventilation does not directly manage the problem at hand. Thus, clamping the chest tube is the most appropriate response to safeguard the patient's health while further investigation can be conducted.