A chest tube (thoracostomy tube) is a flexible, hollow drain placed through the chest wall into the pleural space, the area between the lung and the inner chest wall. Its primary function is to remove accumulated air, fluid, or blood that can impair lung function or cause collapse. Conditions like a collapsed lung (pneumothorax), fluid buildup (pleural effusion), or blood accumulation (hemothorax) require placement to restore normal negative pressure and allow the lung to fully re-expand. The tube remains connected to a closed drainage system until the underlying medical condition is resolved.
Clinical Criteria for Removal
The decision to remove a chest tube is a medical judgment based on objective clinical data confirming the lung is healed and stable. A primary metric is the volume of fluid draining from the tube. Removal is considered when output has decreased to a minimal level, often defined as less than 200 to 300 milliliters over 24 hours.
For patients with air in the pleural space, the resolution of any air leak is required. This is confirmed by observing the water seal chamber for 12 to 24 hours to ensure no air bubbles are present, even when the patient coughs. A chest X-ray provides final confirmation, demonstrating that the lung has achieved full and sustained re-expansion. A trial period on a water seal without suction may be performed to ensure the lung maintains expansion before complete removal.
The Procedure Step by Step
Preparation and Positioning
The removal procedure begins with ensuring patient comfort, often by administering pain medication about 30 minutes prior to manage discomfort. The medical team prepares supplies, including sterile gloves, a suture removal kit, and a specialized occlusive dressing, such as petroleum-impregnated gauze. The patient is positioned in a semi-Fowler’s position (sitting up at a 30 to 45-degree angle) to maximize accessibility to the chest wall.
Securing the Site
The provider removes the protective dressing and cleanses the area around the insertion site. The anchor suture, which secures the tube to the skin, is carefully cut and removed. If a purse-string suture was placed during insertion, it is left ready to be quickly tightened after removal to seal the wound. The tube is then disconnected from the drainage system.
Tube Extraction
The patient is instructed to perform the Valsalva maneuver at the moment of removal. This involves taking a deep breath and holding it to increase pressure within the chest. This temporary increase in intrathoracic pressure prevents air from rushing back into the pleural space. During this maneuver, the provider removes the tube with a single, swift, and steady motion. The speed of removal minimizes the time the pleural space is exposed to outside air.
Sealing the Wound
Immediately after the tube exits the chest wall, the pre-placed purse-string suture is rapidly tied down, or a sterile occlusive dressing is applied to seal the tract completely. The goal is to create an airtight seal over the insertion site within seconds. This maintains the negative pressure required for lung expansion.
Monitoring and Follow-Up Care
Immediate Monitoring
After the tube is removed and the site is sealed, the patient is closely monitored for signs of respiratory distress, such as shortness of breath or chest pain. Vital signs, including oxygen saturation and heart rate, are checked frequently, often every 15 minutes for the first hour, to identify potential complications quickly. The provider listens to the patient’s lungs to confirm bilateral air entry and check for abnormal sounds.
Post-Removal Imaging
A follow-up chest X-ray is typically ordered within a few hours (usually 2 to 12 hours) after removal. This confirms that the lung remains fully expanded and that no new air or fluid collection has developed. A routine post-removal X-ray is common practice to ensure patient safety. The occlusive dressing must remain intact for at least 48 hours to allow the tract to begin healing and prevent air entry.
Recovery and Restrictions
Patients are advised to keep the dressing clean and dry and to watch for signs of infection, including increased redness, swelling, fever, or excessive drainage. During the initial recovery phase, strenuous activities, heavy lifting, and intense exercise are restricted. This allows the internal chest tissues to heal completely. Normal activity is gradually resumed over several weeks, guided by the healthcare team.