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Air bubbling through the water seal chamber intermittently is normal when the patient coughs or exhales, but if there is continuous air bubbling in the chamber, it can indicate a leak that should be evaluated.
The water in the water-seal chamber should rise with inhalation and fall with exhalation (this is called totaling), which demonstrates that the chest tube is patent. Continuous bubbling may indicate an air leak, and newer systems have a measurement system for leaks the higher the number, the greater the air leak.
Air bubbling through the water seal chamber intermittently is normal when the patient coughs or exhales, but if there is continuous air bubbling in the chamber, it can indicate a leak that should be evaluated.
Intermittent bubbling, correspond- ding to respirations in the water- seal chamber, indicates an air leak from the pleural space. It should resolve as the lung reexpands. If bubbling in the water-seal CHAM- BER is continuous, suspect a leak in the system.
Start by examining the air-leak detection chamber in the water seal of the drainage device. An air leak presents as small air bubbles. The amount of bubbling indicates the degree of the leak. If you notice bubbling, determine location of the leak.
Totaling is the rise and fall of fluid in the water seal tube chamber, which is a direct reflection of the degree of lung re-expansion. Totaling decreases as the lung re-expands. In order to observe totaling when suction is used, suction may be temporarily disconnected.
You should see fluctuation (totaling) of the fluid level in the water-seal chamber. If you don't, the system may not be patent or working properly, or the patient's lung may have reexpanded. Look for constant or intermittent bubbling in the water-seal chamber, which indicates leaks in the drainage system.
Be aware that tidalingfluctuations in the water-seal chamber with respiratory efforts normal. The water level increases during spontaneous inspiration and decreases with expiration. If bubbling in the water-seal chamber is continuous, suspect a leak in the system.

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