From the Guidelines
Chest tube removal should be performed when the drainage is less than 1 mL/kg/24 h or 25-60 mL total in a 24-hour period, and there is no air leak, as this approach minimizes the risk of complications and improves patient outcomes. When considering chest tube removal, it is essential to assess the patient's clinical status, including the amount of fluid drainage, presence of air leaks, and lung re-expansion on chest X-ray 1. The procedure for removal involves adequate pain management, which can be achieved with intravenous opioids or local anesthesia, and the patient should be positioned comfortably, typically semi-recumbent or lying flat. Key steps in the removal technique include:
- Cutting the suture securing the tube
- Instructing the patient to perform the Valsalva maneuver or exhale completely and hold
- Removing the tube quickly in one smooth motion
- Covering the site with a petroleum gauze dressing followed by an occlusive dressing Post-removal, a chest X-ray should be obtained to confirm the absence of pneumothorax or fluid reaccumulation, and complications such as recurrent pneumothorax, surgical emphysema, infection, and bleeding at the insertion site should be monitored 1. It is also important to note that the timing of elective removal depends on various factors, including clinical resolution, amount of fluid draining, and patient's overall well-being, and that there is no evidence base to guide this decision, making clinical experience essential 1.
From the Research
Chest Tube Removal
- The provided studies do not directly address the topic of chest tube removal, but rather focus on chemical pleurodesis and the management of pleural effusions 2, 3, 4, 5.
- However, the study by 6 provides a comprehensive review of chest tube management, including the types of chest tubes, indications for use, techniques for placement, and common anatomical landmarks encountered with placement and management.
- The review by 6 also discusses the management of chest tubes during the COVID-19 pandemic and explores the future direction of chest tubes.
- In terms of chest tube removal, it is likely that the decision to remove a chest tube would depend on various factors, including the patient's clinical condition, the presence of any complications, and the effectiveness of the pleurodesis procedure 2, 3, 4, 5.
- The study by 4 reports a median hospitalization of 9 days and a median survival time of 32 days after talc slurry pleurodesis, suggesting that chest tube removal may be considered after a period of stability and improvement in the patient's condition.
- Further research is needed to provide specific guidance on the optimal timing and management of chest tube removal.