Do you clamp the chest tube when transferring?

September 25, 2025 •

4 min read

According to expert consensus and standard medical protocol, a chest tube should almost never be clamped when transferring a patient due to the risk of a life-threatening tension pneumothorax. This essential guideline ensures patient safety by maintaining a clear pathway for air and fluid drainage during transport.

Quick Summary

A chest tube should not be clamped during patient transfer; instead, the suction is disconnected and the system is managed with a water seal or gravity drainage, ensuring a constant escape route for air and fluid.

Key Points

Avoid Routine Clamping: Never routinely clamp a chest tube for patient transfer due to the severe risk of creating a tension pneumothorax.
Maintain Gravity Drainage: During transport, disconnect the system from wall suction and rely on gravity or the built-in water seal for continuous drainage.
Keep Below Chest Level: Always ensure the drainage unit is kept upright and below the patient's chest level to prevent backflow of fluid.
Check for Kinks: Regularly inspect the tubing for kinks or loops that could obstruct drainage and increase intrathoracic pressure.
Use Clamps Momentarily: Only use clamps for specific, temporary procedures like changing the drainage unit or locating a leak, and only with a healthcare provider's order.
Watch for Signs of Distress: Continuously monitor the patient for any signs of respiratory distress, which could signal a complication caused by a kinked or improperly managed tube.

Understanding Chest Tube Clamping Risks

Clamping a chest tube, especially during patient transport, is a dangerous and outdated practice. The primary risk associated with clamping is the development of a tension pneumothorax. This occurs when air becomes trapped in the pleural space, unable to escape. With every breath, more air is pulled into the space, increasing the pressure and eventually collapsing the lung. This rising pressure can also push on the mediastinum, shifting the heart and major blood vessels, which is a medical emergency with potentially fatal consequences.

For a patient with a functioning air leak, clamping the tube can rapidly worsen their condition. During transfer, patients are moved, which can increase intrathoracic pressure and the need for the tube to function properly. Therefore, the standard of care dictates that the chest tube remains unclamped and connected to its drainage system, allowing gravity to facilitate drainage even when suction is not in use.

The Correct Procedure for Patient Transfer

Transporting a patient with a chest tube requires careful, standardized procedures to ensure safety and continuity of care. The key is to manage the drainage system properly without interrupting the therapeutic drainage.

Before Transfer

Gather Equipment: Ensure the entire chest drainage system is ready for transport. This includes a portable drainage unit and, if necessary, portable suction. Confirm the unit is properly filled and functioning.
Assess the Patient: Perform a quick but thorough assessment of the patient's respiratory status. Note the rate and quality of breathing, lung sounds, and oxygen saturation. Confirm the patency of the chest tube and connections.
Prepare the System: Disconnect the chest drainage system from wall suction. Place the patient on a water seal, ensuring the system remains upright and below the patient's chest level. This prevents fluid from re-entering the pleural space and allows air to continue to exit.

During Transfer

Maintain Drainage: Keep the drainage unit securely positioned and always below the level of the patient's chest. Use a designated holder on the stretcher or bed to prevent accidental tipping.
Secure Tubing: Check that the tubing is free of kinks or dependent loops. These can obstruct drainage and inadvertently cause a pressure buildup, mimicking a clamped tube.
Monitor Closely: Continuously monitor the patient's respiratory status throughout the transfer. Watch for any signs of respiratory distress, which could indicate a malfunction or complication. Observe the water seal chamber for tidaling (fluctuations) and air leaks.

Upon Arrival

Reconnect Suction: Once at the new location, immediately reconnect the chest drainage system to the new wall suction as prescribed, if necessary. Confirm that the suction is set to the correct level and functioning properly.
Re-evaluate: Perform a full respiratory assessment and document the patient's condition and the status of the drainage system.

Comparison of Transport Methods: Clamping vs. Gravity Drainage


Feature	Clamping During Transfer (Incorrect)	Water Seal / Gravity Drainage (Correct)
Primary Risk	High risk of creating a tension pneumothorax, a life-threatening condition.	Minimal risk, as air and fluid can continue to escape the pleural space.
Air/Fluid Pathway	Obstructed. Traps air and fluid, leading to dangerous pressure buildup.	Unobstructed. Allows for continuous, safe drainage of air and fluid.
Patient Monitoring	Difficult to assess for air leaks or lung re-expansion accurately during transport.	Tidaling in the water seal chamber allows for ongoing assessment of lung status.
Application	Only used in very specific, momentary situations (e.g., system change, finding a leak) and never routinely for transport.	The standard, recommended procedure for all chest tube transports.
Outcome	Can lead to respiratory collapse, cardiac compromise, and increased morbidity.	Ensures patient stability and promotes continued healing during movement.

Special Considerations for Chest Tube Management

While clamping is generally avoided, there are specific, authorized instances where it may be performed, but only under strict medical supervision and for a limited duration. These include:

Assessing Air Leaks: Briefly clamping the tube can help a clinician localize the source of a persistent air leak within the system.
Changing the Drainage System: A brief, momentary clamp is required when disconnecting the old unit to connect a new, sterile one. It is unclamped as soon as the new system is secured.
Trial Before Removal: Sometimes, a physician may order a trial period of clamping before chest tube removal to assess if the patient can tolerate being without the drain. This is only done after a leak has sealed and is performed with close monitoring.

The Role of the Drainage System and Caregiver

The chest drainage system is engineered to provide a safe, one-way exit for air and fluid. Even when disconnected from suction, the water seal or one-way valve continues to function by leveraging gravity. The caregiver's role is to ensure the integrity of this system at all times. This means preventing kinks in the tubing, keeping the unit upright and below chest level, and being vigilant for any signs of patient distress. Always have rubber-tipped clamps available at the bedside for emergencies, but only use them according to agency policy for very specific, provider-ordered procedures, never for routine transport. Proper technique and adherence to protocol are paramount in preventing severe complications and ensuring a safe transfer for the patient.

For more detailed protocols and guidelines on chest drain management, including information on specific equipment and procedures, consult authoritative medical resources such as the National Center for Biotechnology Information's library on thoracic procedures.

Conclusion: Prioritizing Patient Safety

To answer the question, do you clamp the chest tube when transferring? The unequivocal answer is no. This action carries a high risk of causing a tension pneumothorax, a severe and life-threatening complication. The correct procedure involves ensuring the chest drainage system remains on water seal or gravity drainage, kept upright and below the patient's chest, and completely free of kinks. Adherence to this critical safety protocol is vital for ensuring the best possible outcome for the patient during any movement or transport.

Frequently Asked Questions

The biggest risk is causing a tension pneumothorax, a life-threatening condition where air gets trapped in the chest, increasing pressure and potentially collapsing the lung and shifting the heart.

When transporting a patient, disconnect the chest tube from wall suction. The system should remain on water seal, and the drainage unit must be kept below the patient's chest level at all times.

If the tubing becomes disconnected from the suction source, you should not clamp it. Instead, ensure the patient is on water seal drainage and re-establish suction as soon as possible.

Clamping is only done for very specific, momentary reasons and with a healthcare provider's order. This includes briefly clamping to change a drainage unit or to perform a brief clamp trial before removal.

In the event of a disconnection, re-establish the water seal immediately by placing the end of the tube into a bottle of sterile water or saline. Do not clamp if there is an active air leak.

Moving the patient can create shifts in intrathoracic pressure. This is why it is essential to ensure the chest tube system remains patent (unclamped and without kinks) and is positioned correctly below chest level during all transfers.

To prevent accidental pulling, secure the tubing to the patient's clothing or bedding. Ensure the drainage unit is securely attached to a bed or trolley to prevent tipping or catching on obstacles.