Wound Dressing After 1 Week of Chest Tube Removal
After one week of chest tube removal, when the wound site has properly healed, dressing changes can be reduced to every 2-3 days using simple soap and water cleansing, or the wound can be left exposed with just a simple plaster if there are no signs of infection or drainage. 1, 2
Initial Week Post-Removal (Days 1-7)
During the first week after chest tube removal, the wound requires more intensive care:
- Daily dressing changes are recommended during this initial healing period to prevent infection and promote proper wound healing 1, 2
- The wound site must be monitored daily for signs of bleeding, pain, erythema, induration, leakage, and inflammation 3, 1
- Cleanse the wound at each dressing change with 0.9% sodium chloride solution, sterile water, or freshly boiled and cooled water 3, 1
- Apply a sterile, breathable dressing that does not shed fibers—avoid occlusive dressings as they promote moisture and can lead to skin maceration 3, 2
Alternative Closure Methods at Removal
At the time of chest tube removal, you have two evidence-based options:
- Cyanoacrylate tissue adhesive (Dermabond) can be applied directly at the chest tube site, eliminating the need for bulky bandages and avoiding discomfort from adhesive removal 4
- Standard occlusive gauze dressing with transparent adhesive provides an air-tight seal and allows visualization of drainage 4, 5
Both methods show equivalent safety profiles with no wound dehiscence, complications, or surgical site infections in comparative studies 4
After Initial Healing (Beyond Week 1)
Once the wound has properly healed (typically after 7 days):
- Reduce dressing changes to every 2-3 days rather than daily 1, 2
- Cleanse with soap and water of drinking quality—sterile solutions are no longer necessary 1
- A simple plaster around the wound may be sufficient instead of complex dressings 1
- The wound can be left exposed if completely healed with no drainage 3, 6
Factors Requiring More Frequent Changes
Continue daily or more frequent dressing changes beyond one week if:
- Excessive wound exudate saturates the dressing before the scheduled change 1
- Signs of infection appear: increased pain, erythema, purulent drainage, or fever 1, 2
- The dressing becomes damp, loosened, or soiled 1
- The patient is diaphoretic, requiring more frequent changes due to increased moisture 1
Critical Pitfalls to Avoid
Do not use advanced dressings (hydrocolloid, silver-containing, or film dressings) over standard dressings for primarily closed surgical wounds—there is no evidence they reduce surgical site infection rates compared to basic wound contact dressings 3, 6
Avoid removing dressings before 48 hours unless leakage occurs, as this is the minimum time recommended for surgical wound dressings to remain undisturbed 3, 7
Never apply occlusive dressings as they create a moist environment that promotes skin maceration and potential infection 3, 2
Ensure complete drying of the wound area after cleansing to prevent maceration of surrounding tissue 3, 1
Evidence Quality Note
The evidence on wound dressing superiority is of very low to low certainty, with most studies showing no significant difference between dressing types in preventing surgical site infections 3, 6. Therefore, decisions about dressing type after the first week can be based on cost, patient preference, and clinical assessment of wound healing rather than concerns about infection prevention 3, 6