What is the normal output for a chest tube (thoracostomy tube)?

From the Guidelines

Normal chest tube output varies depending on the clinical context, but generally ranges from 50 to 200 mL in the first 24 hours after placement, with a recent study suggesting that earlier drain removal following thoracic surgery, at higher than traditionally accepted drain outputs (450 mL·day−1), is safe and efficacious 1.

Clinical Context

The output should progressively decrease over time. For pleural effusions, initial drainage may be higher (500-1000 mL) but should then decrease.

• For pneumothorax management, minimal serous fluid output (less than 50-100 mL/day) is expected.
• Bloody drainage should decrease to serous drainage within 24-48 hours post-surgery or trauma.

Monitoring and Removal

Chest tube output exceeding 200 mL/hour or 1500 mL in 24 hours is considered excessive and requires immediate medical attention 1.

• The color should transition from bloody to serosanguineous to serous as healing progresses.
• Output monitoring is essential as persistent high volumes may indicate ongoing bleeding, while sudden cessation could suggest tube obstruction rather than resolution.
• Chest tubes are typically removed when drainage is less than 150-200 mL per 24 hours, the fluid is non-bloody, and imaging confirms lung re-expansion or resolution of the underlying condition 1.

Key Considerations

It is crucial to consider the clinical context and the underlying condition being treated when evaluating chest tube output.

• The recent study 1 provides guidance on the management of pleural effusions and suggests that a protocolised pathway for intervention can result in improved outcomes.
• The study 1 provides a framework for evaluating bleeding and transfusions in clinical research, which can be applied to the management of chest tube output.

From the Research

Normal Chest Tube Output

• The normal chest tube output can vary depending on the patient's condition and the reason for the chest tube insertion 2.
• There is no specific reference to normal chest tube output in the provided studies, as they focus on the treatment of empyema and pleural infection rather than the normal output of chest tubes.
• However, the studies do mention the use of chest tubes and the administration of fibrinolytics to treat empyema and pleural infection, which can affect the output of the chest tube 3, 4, 5, 6.
• The output of a chest tube can be influenced by various factors, including the patient's underlying condition, the presence of infection or inflammation, and the effectiveness of the treatment 2.

Factors Affecting Chest Tube Output

• The presence of purulence in the pleural fluid can affect the output of the chest tube, with purulent fluid often indicating a more severe infection 5.
• The use of fibrinolytics, such as urokinase, can also affect the output of the chest tube by breaking down fibrin clots and improving drainage 3, 4, 6.
• The size and type of chest tube used can also influence the output, with larger tubes often allowing for greater drainage 2.

Clinical Implications

• Understanding the factors that affect chest tube output is important for clinicians to manage patients with chest tubes effectively 2.
• Monitoring the output of a chest tube can help clinicians assess the patient's response to treatment and identify potential complications 3, 4, 5, 6.