Is it common to have no output from a chest tube (chest drainage tube) the first night after placement?

No Output from Chest Tube First Night After Placement

It is common to have no output from a chest tube during the first night after placement, especially if the tube was placed for pneumothorax rather than pleural effusion. 1

Understanding Chest Tube Output Patterns

The British Thoracic Society (BTS) guidelines for management of spontaneous pneumothorax provide insight into expected chest tube function and drainage patterns:

• For pneumothorax: Initial output may be minimal or absent if the tube is primarily evacuating air rather than fluid
• For pleural effusions: Output is typically more immediate and measurable in volume

Normal Timeline for Chest Tube Drainage

• Small-caliber chest tubes (10-14F) used for pneumothorax typically have a median drainage time of 2-4 days 1
• Studies using small lumen catheters (2mm) showed successful treatment with a mean drainage time of 48 hours 1
• The absence of output in the first 24 hours does not necessarily indicate tube malfunction

Assessing Chest Tube Function

When evaluating a chest tube with no output in the first night, consider:

1. Type of condition being treated:

   • Pneumothorax: Air evacuation may not register as "output"
   • Pleural effusion: Should typically show fluid drainage

2. Signs of proper function:

   • Bubbling in the water seal chamber (for pneumothorax)
   • Respiratory variation in the water seal chamber
   • Improvement in patient's clinical status
   • Radiographic improvement on follow-up imaging

3. Concerning signs that require attention:

   • Worsening respiratory distress
   • Development of subcutaneous emphysema
   • Persistent pneumothorax on imaging
   • Patient discomfort around tube site

Potential Causes of No Output

1. Normal physiological response:

   • Complete evacuation of air/fluid during initial placement
   • Minimal ongoing production of air/fluid

2. Technical issues:

   • Tube malposition or kinking
   • Blockage by blood clot or fibrin
   • Connection system problems

Management Recommendations

If a chest tube shows no output in the first night:

1. Verify tube position with chest radiograph
2. Assess for respiratory variation in the water seal chamber
3. Evaluate patient clinically for improvement in symptoms
4. Do not clamp a bubbling chest tube as this could convert a simple pneumothorax into a tension pneumothorax 1
5. Consider tube repositioning only if clinical deterioration occurs or follow-up imaging shows inadequate evacuation

Important Considerations

• The BTS guidelines indicate that persistent air leak is defined as continued bubbling through an intercostal tube 48 hours after insertion, not immediately 1
• Suction should not be applied directly after tube insertion but can be considered after 48 hours if there is persistent air leak or failure of pneumothorax to re-expand 1
• Small-bore tubes (10-14F) are as effective as large tubes (20-24F) for most pneumothoraces 1

When to Be Concerned

Seek immediate medical attention if:

• Patient develops respiratory distress
• Subcutaneous emphysema develops or worsens
• Patient becomes hemodynamically unstable
• Chest radiograph shows worsening pneumothorax or new effusion

Remember that chest tube management requires close monitoring, and the absence of output in the first night is often normal, particularly for pneumothorax management.