病人的胸管連接到水封引流系統。護理師注意到水封室內有持續性的氣泡。這代表什麼？
A client has a chest tube connected to a water-seal drainage system. The nurse notes continuous bubbling in the water-seal chamber. What does this indicate?
- AThe system is functioning correctly系統運作正常
- BThe suction pressure is too high抽吸壓力過高
- CThe lung has fully re-expanded肺部已完全復張
- DThere is an air leak in the system✓ 正解系統中有空氣洩漏
胸腔引流系統的水封室（Water-seal chamber）設計是用來讓氣體排出胸膜腔，同時防止空氣倒流回體內。在正常情況下，水封室應觀察到與呼吸同步的波動（Tidaling）。若病人有氣胸，在咳嗽或呼氣時出現「間歇性」氣泡是正常的。然而，「持續性」氣泡（Continuous bubbling）則是系統中有漏氣（Air leak）的明確徵兆。漏氣可能發生在引流管連接處、引流瓶破損，或是病人的肺部傷口未癒合。臨床思路上，護理師應從靠近病人的端點開始檢查管路，確保所有連接緊密，並評估病人呼吸音。
The water-seal chamber of a chest drainage system is designed to allow air to escape from the pleural space while preventing air from re-entering the body. Under normal conditions, the water-seal chamber should show tidaling synchronized with respiration. In a patient with pneumothorax, intermittent bubbling with coughing or expiration is normal. However, continuous bubbling is a definitive sign of an air leak in the system. The leak may occur at a tubing connection, in a damaged drainage bottle, or at an unhealed lung wound. Clinically, the nurse should check the tubing systematically starting from the patient's end, ensure all connections are tight, and assess the patient's breath sounds.
兩地使用的引流瓶（如 Pleur-evac）原理相同。NCLEX 常考一個關鍵動作：不可常規夾閉（Clamp）胸管，除非是為了尋找漏氣點或更換引流瓶，因為夾閉可能導致張力性氣胸，這點在台美臨床皆為禁忌。