Chest Tube Removal Procedure

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Audience

Physician or equivalent

Make sure chest tube is ready to be pulled out.

1. No air leak with coughing or mechanical breath.
2. Successful water seal trial.
3. No pneumothorax on CXR taken 12-24 hrs after chest tube placed to water seal.

 

Preparation

1. Remove dressing covering chest tube entry site.
2. Undue or cut holding stitch.
3. If a purse string suture is in place make sure it is able to be tied down after tube is removed. Not all chest tubes are placed with a purse string suture. If the patient’s chest wall is appropriately thick and the chest tube has been tunneled properly a purse string suture may not be necessary.
4. Obtain piece of petroleum gauze or Xeroform and sterile 4x4.
5. For patients on the mechanical ventilator you want to time your pulling so you are on the inspiratory phase of positive pressure phase of the ventilator cycle.
6. Clamp chest tube with a Kelly clamp prior to pulling.

 

Pulling chest tube

1. Make sure if purse string suture is used, it has one loose throw in it and is ready to tie.
2. Have nurse or assistant hold Vaseline gauze and 4x4 dressing over superior aspect of chest tube entry site.
3. Pull chest tube quickly and forcefully with appropriate timing.
4. Tie down purse string suture, if present.
5. Release pressure on the gauze dressing and tape in place.
6. Obtain post pulling CXR and check results as soon as film is done.

 

Dispose of chest tube and pleurovac.

1. Tie pleur-evac line in a knot so fluid will not drain out.
2. Place entire apparatus in red biohazard disposal bag.

 

1. Remove stitches.
   1. Chest tube stitches left behind after pulling chest tube should be removed within 48 hours.