During mobilization with chest tubes, which practice is essential?

• A. Drainage is functioning and secure; monitor for air leaks or pneumothorax; mobilize only when stable and with caution for coughing or Valsalva.
• B. Remove chest tubes before mobilization.
• C. Always perform high-intensity activity to dislodge clots.
• D. Discontinue chest tube care during mobilization.

Answer: (A)

When moving a patient with a chest tube, the key practice is to keep the drainage system functioning and secure, and to move only if the patient is stable while watching for air leaks or signs of a pneumothorax. A chest tube is there to remove air or fluid from the pleural space; if the tube becomes dislodged, kinked, or pulls away from the skin, air can enter or fluid can accumulate, risking a pneumothorax or tension physiology. Therefore, secure the tubing, keep the drainage collection system below chest level, and check for a continuous, expected drainage amount and any new or changing air leaks.

Coughing or Valsalva maneuvers increase intrathoracic pressure and can worsen air leaks or precipitate pneumothorax, so mobilization should be cautious and planned with the patient’s tolerance, often including splinted coughing and incentive spirometry as appropriate. If any new shortness of breath, chest pain, changing breath sounds, or subcutaneous emphysema appears, pause mobilization and reassess with the medical team.

Do not remove the chest tube during mobilization, and avoid pushing for high-intensity activity that could strain the system or worsen the patient's condition. Chest tube care continues during mobilization to maintain a closed, secure drainage pathway and to promptly address issues.