From the Research
After transitioning a chest tube to water seal, the patient should be monitored closely for 24-48 hours for signs of pneumothorax recurrence or respiratory distress, and a chest X-ray should be obtained within 4-6 hours to confirm lung expansion and absence of pneumothorax 1. The water seal trial serves as a test to ensure the lung can remain expanded without suction, as it allows visualization of any air leaks while maintaining the ability to drain fluid and prevent air entry into the pleural space. Some key points to consider during this period include:
- Checking vital signs every 4 hours, including respiratory rate, oxygen saturation, and work of breathing
- Administering appropriate analgesia prior to removal, such as 1-2 mg IV morphine or 25-50 mcg IV fentanyl, about 30 minutes before the procedure
- Applying an occlusive petroleum gauze dressing after removal
- Obtaining a post-removal chest X-ray to ensure no pneumothorax has developed It's also important to note that the optimal timing for tube removal is still a matter of controversy, but the use of digital drainage systems can facilitate informed and prudent decision-making in this area 1. Additionally, a systematic review and meta-analysis found that suction may have a positive effect on duration of chest tube treatment, length of stay in hospital, and persistent air leakage in chest trauma, although the quality of evidence was low to moderate according to GRADE 2. However, the most recent and highest quality study should be prioritized, and in this case, the study from 2018 provides the most relevant guidance for clinical practice 1. If the patient remains stable with no air leak, no fluid accumulation, and the lung remains fully expanded on imaging, the chest tube can typically be removed 1.