After a chest drainage system water-seal chamber is spilled, what should the neonatal/pediatric specialist do?

• A. Immediately clamp the chest tube
• B. Connect the chest tube to wall suction
• C. Leave the chest tube open to air
• D. Remove any PEEP set on the ventilator

Answer: (C)

When the water-seal chamber is spilled, the one-way barrier that prevents air from moving back into the pleural space is lost. With that seal gone, actions like clamping or actively suctioning can trap air or worsen a leak, increasing the risk of a tension pneumothorax. The safest immediate step is to leave the chest tube open to air, so any air escaping from the pleural space can vent to the atmosphere. This minimizes dangerous pressure buildup while you promptly replace the drainage system with a functional sterile water-seal setup and continue to monitor the patient closely.