From the Guidelines
After clamping a pleural drain that has drained 1 liter, the drain can be removed when the drainage is less than 300 mL/day, as long as there are no air leaks and the patient's clinical condition is stable, as recommended by the most recent guidelines 1. The decision to remove the pleural drain should be based on clinical assessment, including the patient's symptoms, vital signs, and chest imaging results.
- The initial drainage of 1 liter is significant and suggests an underlying pathology that may continue to produce fluid.
- Clamping trials are typically performed to assess if the patient can tolerate removal of the drain, but if symptoms develop during this trial, it indicates that the underlying condition is still active and drainage should be resumed.
- The guidelines recommend removing the chest drain as soon as possible, when serous pleural drainage is <300 mL/day, and there are no air leaks 1.
- It is essential to monitor the patient's condition closely after removing the drain and to be prepared to restart drainage if necessary.
- The use of digital chest drainage systems and suction drainage can help to facilitate the removal of the drain and reduce the risk of complications 1.
- Ultimately, the decision to remove the pleural drain should be made on a case-by-case basis, taking into account the individual patient's needs and clinical condition.
From the Research
Pleural Drain Removal Criteria
The optimal timing for removing a pleural drain is still a matter of controversy 2. However, several studies provide guidance on this issue.
- A randomized study found that increasing the threshold of daily drainage to 200 mL before removing the chest tube did not markedly affect drainage, hospitalization time, or overall costs, nor did it increase the likelihood of major pleural fluid reaccumulation 3.
- The study suggests that a volume of 200 mL/d of uninfected drainage could be used as a threshold for removal of chest tube 3.
- Another study found that pleural sclerosis was successful in 71% of patients with malignant pleural effusions, but all failures were in patients with more than 100 ml/day of chest-tube drainage 4.
- In the context of the provided 1000ml drainage, it is essential to consider the daily drainage volume rather than the total volume drained 3, 4.
Clamping and Removal Procedure
- A drain-clamping test before tube withdrawal is generally not advocated 2.
- Chest drains are usually removed under medical instructions when the patient's lung has inflated, the underlying condition has resolved, and there is no evidence of respiratory compromise or failure 5.
- The removal procedure requires two practitioners and should be done in a safe and effective manner 5.
Considerations for Removal
- The decision to remove a pleural drain should be based on the patient's individual condition, including the resolution of the underlying condition and the absence of respiratory compromise or failure 5.
- The daily drainage volume, rather than the total volume drained, should be considered when deciding to remove the chest tube 3, 4.