There’s lots of info out there on how to put a chest tube in. But what about on taking it out? There are a few nuances that you should be aware of so you can do this as quickly and complication-free as possible.
Have a look at this 5 minute video and let me know what you think. Please leave your comments on YouTube.
Chest tubes are needed occasionally to help manage chest injuries. How do you decide when they are ready for removal?
Unfortunately, the literature is not very helpful in answering this question. To come up with a uniform way of pulling them, our group looked at any existing literature and then filled in the (many) blanks, negotiating criteria that we could all live with. We came up with the following.
Removal criteria:
Removal sequence:
Click here to download the full printed protocol.
Pneumothorax is typically diagnosed radiographically. Significant pneumothoraces show up on chest xray, and even small ones can be demonstrated with CT.
Typically, a known pneumothorax is followed with serial chest xrays. If patient condition permits, these should be performed using the classic technique (upright, PA, tube 72″ away). Unfortunately, physicians are used to ordering the chest xray as a bundle of both the PA and lateral views.
The lateral chest xray adds absolutely no useful information. The shoulder structures are in the way, and they obstruct a clear view of the lung apices, which is where the money is for detecting a simple pneumothorax. The xray below is of a patient with a small apical pneumothorax. There is no evidence of it on this lateral view.
Bottom line: only order PA views (or AP views in patients who can’t stand up) to follow simple pneumothoraces. Don’t fall into the trap of automatically ordering the lateral view as well!
This unit has been knocked over. Note the blood in both collection columns on the right. In this case, the water seal and pressure chambers have also been compromised (area on the left).
Collection systems that have been knocked over frequently malfunction and should be changed immediately! (It’s also impossible to accurately measure tube output after this happens)
An air leak is a sure-fire reason to keep a chest tube in place. Fortunately, many air leaks are not from the patient’s chest, but from a plumbing problem. Here’s how to locate the leak.
To quickly localize the problem, take a sizable clamp (no mosquito clamps, please) and place it on the chest tube between the patient’s chest and the plastic connector that leads to the collection system. Watch the water seal chamber of the system as you do this. If the leak stops, it is coming from the patient or leaking in from the chest wall.
If the leak persists, clamp the soft Creech tubing between the plastic connector and the collection system itself. If the leak stops now, the connector is loose.
If it is still leaking, then the collection system is bad or has been knocked over.
Here are the remedies for each problem area:
Note: If you are using a “dry seal” system (click here for more on this) you will not be able to tell if you have a leak until you fill the seal chamber with some water.