What materials are needed for chest tube removal?

Materials Needed for Chest Tube Removal

For chest tube removal, essential materials include sterile gloves, sterile dressings, suture removal kit, occlusive dressing, and scissors. 1

Essential Equipment

• Personal Protective Equipment:

  • Sterile gloves 1
  • Gown 1
  • Eye protection 2
  • Mask 2

• Wound Care Materials:

  • Sterile dressing pack 2
  • Occlusive dressing (transparent adhesive dressing or gauze with transparent occlusive adhesive) 3, 4
  • Sterile scissors 2
  • Suture removal kit (if chest tube was sutured in place) 2
  • Stitch cutter (if applicable) 2

• Optional Materials Based on Institutional Protocol:

  • Cyanoacrylate tissue adhesive (Dermabond®) as an alternative to traditional dressings 3
  • Pain medication (typically intravenous morphine sulfate) for pre-procedure administration 5

Preparation Steps

1. Gather all necessary equipment before beginning the procedure to ensure a smooth, efficient removal process 1

2. Verify that removal criteria are met:

   • No air leakage present 6
   • Drainage volume of 400 ml or less in 24 hours (institutional protocols may vary) 6
   • Chest radiograph confirming lung expansion 2

3. Administer pain medication before the procedure as chest tube removal can be painful 5

   • Only 16% of institutions routinely prescribe pain medication before chest tube removal, but this is considered best practice 5

Removal Procedure

1. Position the patient appropriately, typically in semi-Fowler's position 1

2. Remove any existing dressing around the chest tube insertion site 1

3. Cut the suture that secures the chest tube in place while maintaining control of the tube 2

4. Instruct the patient to perform the Valsalva maneuver or to exhale and hold their breath during removal to prevent air entry 2

5. Remove the chest tube in a swift, controlled motion while an assistant immediately applies the occlusive dressing 4

6. Apply sterile dressing to create an airtight seal 1, 4

   • Traditional method: Apply gauze with transparent occlusive adhesive dressing 3
   • Alternative method: Apply cyanoacrylate tissue adhesive directly to the wound 3

Post-Removal Monitoring

1. Assess the patient for signs of respiratory distress or complications 1

2. Obtain a post-removal chest radiograph to confirm the absence of pneumothorax 1

3. Document the procedure including time of removal, patient's tolerance, and condition of the site 1

Common Pitfalls and How to Avoid Them

• Inadequate pain management: Ensure appropriate analgesia is administered before the procedure 5

• Air entry during removal: Proper timing with patient's breathing cycle and immediate application of occlusive dressing can prevent this 2

• Unsightly scarring: Consider using knotless suture material or tissue adhesives for wound closure to minimize scarring 7

• Failure to create an airtight seal: Ensure the dressing completely covers the wound and creates an occlusive barrier 4