A nurse is contributing to the plan of care for a client who has a chest tube set to continuous suction to relieve a pneumothorax. Which of the following interventions should the nurse include?

Chest tube management is essential in clients with conditions such as pneumothorax, where air or fluid must be removed from the pleural space to restore normal lung expansion. A chest tube system relies on gravity and a water-seal drainage setup to prevent backflow and maintain proper drainage. Incorrect positioning or handling can lead to complications such as tension pneumothorax or loss of negative intrathoracic pressure. Nursing care focuses on maintaining patency, ensuring proper system function, and preventing complications. Rationale: A. Clamping the chest tube every 4 hours is contraindicated unless specifically ordered for a brief and controlled purpose, such as changing the drainage system. Routine clamping can cause pressure buildup in the pleural space, potentially leading to a tension pneumothorax, which is life-threatening. Continuous, unobstructed drainage is essential for safe management. B. Emptying the collection chamber every 8 hours is not standard practice for chest tube drainage systems. The drainage system is typically not emptied by the nurse; instead, the entire collection unit is replaced when full, using sterile technique if required. Frequent manipulation of the system increases infection risk and disrupts the closed drainage system. C. Placing the client in a supine position is not recommended for optimal chest tube drainage or lung expansion. Clients are typically positioned in semi-Fowler’s or high-Fowler’s position to promote lung expansion and facilitate drainage from the pleural space. Supine positioning may reduce respiratory efficiency and impair drainage effectiveness. D. Ensuring the device is kept below the level of the client’s chest is essential for proper chest tube function. This positioning allows gravity to facilitate drainage of air and fluid from the pleural space into the collection chamber. If the system is raised above chest level, there is a risk of backflow, which can compromise respiratory function and increase the risk of complications.