Why do we change the dressing in chest tube (chest thoracostomy tube) dressings?

Chest Tube Dressing Changes: Purpose and Protocol

Chest tube dressings should be changed when they become damp, loosened, or visibly soiled to prevent infection and ensure proper wound healing. 1, 2

Primary Purposes of Chest Tube Dressing Changes

• Infection Prevention: Regular dressing changes help prevent catheter-related infections by maintaining a clean environment around the insertion site 1
• Site Assessment: Allows visual inspection of the insertion site for signs of infection, inflammation, or complications 2
• Maintaining Occlusion: Ensures an air-tight seal around the chest tube to prevent air leaks and maintain proper pleural drainage 3
• Absorption of Drainage: Fresh dressings effectively absorb exudate from the insertion site 2

Recommended Dressing Types and Change Frequency

Dressing Types

• Sterile Gauze: Preferred when the site is bleeding or oozing 1
• Transparent Semi-permeable Dressing: Allows visualization of the site while maintaining a barrier 1
• Chlorhexidine-impregnated Dressings: Recommended for patients over 2 months of age with short-term catheters at high risk for infection 1

Change Frequency Guidelines

• Gauze Dressings: Change every 2 days 1
• Transparent Dressings: Change every 7 days 1
• Immediate Change Required: When dressings become damp, loosened, or visibly soiled 1, 2

Dressing Change Procedure

1. Preparation:

   • Perform hand hygiene
   • Wear clean gloves and surgical mask
   • Prepare a clean field 2

2. Removal of Old Dressing:

   • Carefully remove existing dressing while stabilizing the tube to prevent dislodgement
   • Inspect the site for signs of infection (redness, swelling, drainage, pain) 2

3. Site Cleaning:

   • Clean the insertion site with an appropriate antiseptic (chlorhexidine with alcohol is preferred) 2
   • Allow the antiseptic to dry completely 2

4. New Dressing Application:

   • Apply new sterile dressing (gauze or transparent) based on site condition
   • Ensure occlusive seal around the tube 2
   • Secure dressing to prevent tube movement

Special Considerations

• Tunneled Chest Tubes: Well-healed tunneled tubes may not require dressing to prevent dislodgement, though covering is still recommended in children 1
• Pediatric Patients: Less frequent dressing changes may be considered for patients at high risk of serious complications from catheter dislodgement 1
• Alternative Approaches: Cyanoacrylate tissue adhesive (Dermabond®) has been shown to be effective and safe for closure of chest tube drain sites after removal, potentially reducing discomfort from adhesive removal 4

Common Pitfalls to Avoid

• Excessive Tube Movement: Ensure the tube is stabilized during dressing changes to prevent dislodgement or tissue trauma
• Topical Antimicrobial Overuse: Avoid routine use of topical antimicrobial ointments as they may promote fungal infections and antimicrobial resistance 1
• Submerging in Water: Do not allow the chest tube site to be submerged in water 1
• Delayed Changes: Failing to change soiled or damp dressings promptly increases infection risk 1

By following these evidence-based guidelines for chest tube dressing changes, healthcare providers can minimize infection risk, promote proper healing, and ensure optimal chest tube function while maintaining patient comfort and safety.