From the Guidelines
Chest tube stripping is not recommended as a routine practice due to its potential to cause harm and lack of efficacy, as evidenced by recent guidelines and studies 1. The procedure of stripping a chest tube, which involves compressing the tube externally to clear potential obstructions, can generate excessive negative pressure within the pleural space, potentially causing tissue damage. Instead of stripping, healthcare providers should focus on maintaining chest tube patency through:
- Proper positioning of the chest tube
- Ensuring adequate fluid levels in the water seal chamber
- Encouraging patient mobility when appropriate
- Performing gentle milking of the tube only when clearly indicated by visible clots obstructing drainage If drainage issues persist despite these measures, healthcare providers should assess for tube kinking, patient positioning problems, or consider tube replacement rather than aggressive stripping. The rationale behind avoiding stripping is supported by studies, such as those referenced in the guidelines for perioperative care in cardiac surgery 1, which have shown that chest-tube stripping is ineffective and potentially harmful. Additionally, guidelines recommend against stripping or breaking the sterile field of chest tubes to remove clot, citing the potential for increased infection risk and damage to internal structures 1. Therefore, the indication for stripping a chest tube is essentially nonexistent, and alternative methods for maintaining patency should be prioritized to minimize risks to the patient.
From the Research
Indications for Stripping a Chest Tube
The indications for stripping a chest tube are related to maintaining its patency and ensuring effective drainage. Key points include:
- Preventing occlusion by blood clots, which can lead to tamponade or retained blood syndrome (RBS) 2, 3
- Managing postoperative pericardial effusion with tamponade, where active clearance of the chest tube can help resolve the tamponade 2
- Reducing the need for interventions for RBS and postoperative atrial fibrillation by maintaining chest tube patency 3
- Improving oxygenation and compliance in patients with acute respiratory failure refractory to positive end-expiratory pressure ventilation by draining pleural effusions 4
Conditions Requiring Chest Tube Stripping
Specific conditions that may require chest tube stripping include:
- Cardiac surgery patients to evacuate shed blood from around the heart and lungs 2, 3
- Patients with massive postoperative pericardial effusion with tamponade 2
- Patients with retained blood syndrome (RBS) 3
- Patients with acute respiratory failure and pleural effusions refractory to mechanical ventilation and positive end-expiratory pressure (PEEP) therapy 4