pulmonary disorders
How To Do Tube and Catheter Thoracostomy
Aftercare for Surgical Tube and Catheter Thoracostomy
An anteroposterior chest x-ray should be obtained at the bedside to check the tube’s position. If there are concerns about positioning or functioning of the chest tube, posteroanterior and lateral x-rays or chest CT should be done. The chest tube is removed when the condition for which it was placed resolves. With a pneumothorax, suction is stopped and the tube is placed on just water seal for several hours to ensure that the air leak has stopped and that the lung remains expanded. Chest x-ray is often repeated 12 to 24 hours after the last evidence of an air leak before removing the tube. For pleural effusions or hemothorax, the tube is typically removed when the drainage is < 100 to 200 mL/day of serous fluid. Removal of a chest tube in patients on mechanical ventilation, especially those with high oxygen requirements, positive pressure ventilation, chronic lung disease, or increased risk of recurrent pneumothorax, should be done only after consultation with the pulmonary specialist. To remove the tube, the patient should be semi-erect. After removal of the sutures, at the moment of removal, the patient is asked to take a deep breath and then to forcibly exhale; the tube is removed during exhalation and the site is covered with petroleum gauze, a sequence that reduces the chance of pneumothorax during removal. The purse-string suture, if inserted during tube insertion, is closed, and/or additional sutures may be needed to close the incision. A chest x-ray should be done several hours after chest tube removal. If no pneumothorax is seen on the x-ray after chest tube removal, there is no need for further chest x-rays except as dictated by clinical changes in the patient's condition. 