Is it normal to hear crackles or crepitus on the side of a recent chest tube (chest drainage tube) insertion?

Crackles After Chest Tube Placement: Normal Finding and Management

Hearing crackles or crepitus on the side of a recent chest tube placement is a normal finding and is not necessarily a cause for concern, especially in the early post-procedural period.

Normal Post-Chest Tube Findings

Crackles (also called rales) heard on the side of a recent chest tube insertion can be attributed to several normal physiological processes:

• Air Movement: As the lung re-expands after pneumothorax treatment, air movement through previously collapsed airways can produce crackles 1
• Pleural Irritation: The physical presence of the chest tube can cause local irritation of the pleural surfaces
• Residual Air: Small amounts of residual air in the pleural space during re-expansion
• Tissue Healing: Inflammatory processes at the insertion site and along the tube tract

When Crackles Are Expected

• First 24-48 hours: Most common during this period as the lung re-expands 2
• During Deep Inspiration: More pronounced during deep breathing exercises
• After Tube Manipulation: May increase temporarily after any adjustment of the tube
• After Tube Removal: Can persist for several days after tube removal

When to Be Concerned

While crackles are typically normal, they may indicate complications if accompanied by:

• Worsening respiratory distress
• Development or worsening of subcutaneous emphysema
• Persistent pneumothorax on follow-up imaging
• Fever or signs of infection
• Hemodynamic instability 2

Evaluation of Chest Tube Function

To ensure proper chest tube function when crackles are present:

1. Verify tube position with chest radiograph
2. Assess for respiratory variation in the water seal chamber
3. Evaluate for clinical improvement in symptoms
4. Check for bubbling in the water seal chamber (indicates air evacuation) 2

Important Cautions

• Never clamp a bubbling chest tube as this could convert a simple pneumothorax into a tension pneumothorax 1
• Be aware that up to 30% of chest tubes may have some form of complication, with malposition being the most common 3
• Small-bore tubes (10-14F) are generally as effective as large tubes for most pneumothoraces 2

Follow-up Care

• A follow-up chest radiograph is essential to confirm proper lung re-expansion
• Crackles should gradually diminish as the lung fully re-expands and healing occurs
• If crackles persist beyond 1 week with no improvement, further evaluation may be warranted

Remember that the absence of drainage output in the first 24 hours does not necessarily indicate tube malfunction, especially if the tube was primarily placed to evacuate air rather than fluid 2.