What type of dressing is recommended after removing a chest drain (thoracostomy tube)?

Chest Drain Removal Dressing

A sterile occlusive dressing should be used after chest drain removal to prevent air entry and maintain wound closure. 1

Dressing Selection

The appropriate dressing after chest drain removal should follow these principles:

• Occlusive properties: The primary purpose is to create an airtight seal to prevent air entry into the pleural space 1
• Sterile technique: Essential to avoid wound site infection or secondary empyema 1
• Visibility: Allows for inspection of the drain site for complications 1

Recommended Dressing Options

1. Standard occlusive dressing:

   • Clean, sterile gauze covered by a transparent adhesive dressing
   • Allows for inspection of the drain site while maintaining an occlusive seal
   • Most commonly used approach in clinical practice 1

2. Cyanoacrylate tissue adhesive (medical glue):

   • Effective alternative for closure of chest tube drain sites
   • Appears to be safe with no increased risk of wound complications
   • May be more comfortable for patients by avoiding bulky bandages and painful adhesive removal 2
   • Particularly useful for smaller drain sites

Application Technique

1. Preparation:

   • Use sterile technique with sterile gloves and equipment 1
   • Clean the area around the drain site with antiseptic (betadine or chlorhexidine) 1

2. Drain removal:

   • Requires two practitioners for safety 3
   • One practitioner removes the tube while the other secures the site immediately 3
   • For drains with mattress sutures, one practitioner ties the suture while the other removes the drain 3

3. Dressing application:

   • Apply the occlusive dressing immediately after drain removal
   • Ensure complete coverage of the wound site
   • For standard dressings: apply sterile gauze followed by transparent adhesive dressing
   • For tissue adhesive: apply directly to the closed wound edges after drain removal 2

Monitoring and Management

• Monitor the site for signs of:

  • Air leakage (subcutaneous emphysema)
  • Infection
  • Bleeding
  • Respiratory compromise

• If the patient develops worsening breathing or chest pain after drain removal and dressing application, immediately assess for tension pneumothorax 1

• The dressing should remain in place until the wound has sealed (typically 48-72 hours) 4

Special Considerations

• Purse string sutures are controversial and increasingly considered unnecessary:

  • Some practitioners believe they should not be used as they convert a linear wound into a circular one, which can be painful and leave unsightly scars 1, 5
  • Modern practice increasingly avoids purse string sutures for drain sites 5

• Small bore drains (including pigtail catheters) typically require less extensive dressings than larger surgical drains 1

• Early dressing removal (within 48 hours) appears to have no detrimental effect on outcomes compared to prolonged dressing, and may result in shorter hospital stays and reduced costs 4

Potential Complications

• Pneumothorax after drain removal (requiring further chest drain insertion) 5
• Superficial drain site infections 5
• Leakage from the drain site 5
• Wound dehiscence (rare) 4

By following these evidence-based recommendations for chest drain removal dressings, you can minimize complications and optimize patient comfort and outcomes.