Chest Tube Removal

Summary

Dr. Michael McGonagle, Director of Trauma Programs at Region's Hospital, provides a concise guide on removing a chest tube. He emphasizes the importance of ensuring the patient is ready by checking drainage levels, air leaks, and any residual hemo/pneumothorax. The procedure involves preparing equipment, communicating with the patient, and instructing them to hold their breath or use a respiratory technique. The chest tube is removed swiftly, followed by immediate dressing of the wound. Post-care instructions include keeping the wound dry for 48 hours and scheduling a follow-up visit.

Takeaways

• 🩺 Ensure the patient is ready for chest tube removal by checking for less than 150cc of drainage over 24 hours, no active air leak, and a small or stable residual pneumothorax or hemothorax.
• 🗣️ Communicate clearly with the patient, ensuring they understand the procedure and know when to hold their breath and bear down during tube removal.
• 🛠️ Prepare all equipment in advance, including 4x4 gauze, Vaseline gauze (if preferred), and pre-cut tape to secure the dressing quickly.
• 💡 The Valsalva maneuver (patient holds breath and bears down) prevents air from entering the chest during tube removal; for ventilated patients, a respiratory therapist may perform an inspiratory pause.
• ✂️ Once the stitch holding the tube is cut, hold onto the tube tightly and remove it swiftly while simultaneously placing the dressing over the wound.
• 🩹 Apply the dressing immediately after removing the tube to prevent any air or contaminants from entering the chest cavity.
• ⏱️ Leave the dressing on for 48 hours, and instruct patients not to bathe or shower during this period to keep the wound dry.
• 📝 After 48 hours, the patient can remove the dressing and replace it with a simple Band-Aid, and they may resume bathing or swimming.
• 📅 Schedule a follow-up visit within 1-2 weeks to ensure the wound is healing properly and no complications arise.
• 🚨 Instruct the patient to call their surgeon if they experience increased redness, pain, or other signs of infection before their follow-up.

Q & A

What are the three conditions that must be met before removing a chest tube?

The patient should have less than 150 cc's of drainage over 24 hours, no active air leak, and either no or a small and stable residual hemothorax or pneumothorax.

Why is it important to explain the procedure to the patient beforehand?

It helps ensure the patient understands the procedure and the importance of holding their breath and bearing down during the tube removal, which prevents air from re-entering the chest.

What is the purpose of the Val Salva maneuver or inspiratory pause during chest tube removal?

It prevents air from entering the chest cavity during the tube removal by increasing the pressure inside the chest.

What materials should be prepared before starting the chest tube removal?

Materials include 4x4 dressings, Vaseline gauze (optional), pre-cut tape, and a sterile field. It's important to have everything set up before starting.

What is the role of the stitch holding the chest tube in place?

The stitch secures the chest tube in place. Once the stitch is cut, the tube must be held firmly to prevent it from slipping out unexpectedly.

How should the dressing be applied after the chest tube is removed?

After removing the tube, the dressing should be quickly placed over the site, using pre-cut pieces of tape to secure it in place.

What instructions should be given to a patient after chest tube removal?

The patient should keep the dressing on for 48 hours, avoid getting it wet, and after 48 hours, replace it with a simple Band-Aid. They can shower, bathe, or swim after this period.

When should a follow-up visit be scheduled after chest tube removal?

A follow-up visit should be scheduled within one to two weeks to check the wound's healing progress.

What signs should prompt a patient to contact their surgeon after chest tube removal?

The patient should contact their surgeon if they experience increasing redness, pain, or any other concerning symptoms at the removal site.

What precautions should be taken if the patient is on a ventilator during chest tube removal?

If the patient is on a ventilator, the respiratory therapist should perform an inspiratory pause to mimic the effect of the Val Salva maneuver during the tube removal.