A chest tube is a flexible, hollow tube inserted into the pleural space between the inner lining of the chest wall and the lung. This medical device is used to drain abnormal collections of air, blood, or fluid that accumulate due to injury, surgery, or disease like a collapsed lung (pneumothorax) or a fluid buildup (pleural effusion). The presence of these substances in the pleural space prevents the lung from fully expanding, making breathing difficult. Removal of the chest tube signifies the resolution of the underlying issue, confirming that the lung is no longer leaking air or that the abnormal fluid collection has ceased.
Determining Readiness for Removal
The decision to remove a chest tube is clinical, driven by objective data confirming the lung has recovered function. A primary criterion is the absence of an air leak, confirmed when no bubbling is observed in the drainage system for at least 24 hours, even during a cough. For tubes draining fluid, output must decrease significantly, often to less than 200 to 300 milliliters over 24 hours in an adult patient.
The appearance of the drained fluid is also assessed to ensure it is no longer bloody or purulent. Radiographic confirmation is another important step, where a chest X-ray is performed to show that the lung remains fully expanded without signs of new air or fluid re-accumulation. The timing of removal is strictly based on these medical criteria, which demonstrate that the pleural space has stabilized and sealed itself.
Step-by-Step Removal Process
Preparation begins with patient comfort and positioning. Pain medication is often administered beforehand to manage the expected brief, sharp sensation. The clinician may also inject a local anesthetic, such as lidocaine, around the insertion site. The patient is typically placed in a semi-Fowler’s position, sitting up with the head of the bed elevated, to provide clear access to the site.
The next steps focus on securing the site immediately after tube removal to prevent air from rushing back into the chest. The securing sutures are cut, and the patient is instructed to take a deep breath and hold it, or perform the Valsalva maneuver. This technique involves bearing down while holding the breath, which increases pressure inside the chest and minimizes the risk of air entry.
While the patient holds their breath, the healthcare provider quickly withdraws the tube in a single, continuous motion. Immediately upon removal, the pre-placed closing suture (often a purse-string or mattress stitch) is tied tightly to close the wound track. The rapid motion seals the pleural space; the sensation is brief and uncomfortable, but quickly passes.
Immediate Post-Procedure Care
Once the tube is removed and the wound is closed, an occlusive dressing is applied to maintain an airtight seal. This dressing often includes petroleum-impregnated gauze (like Xeroform or Jelonet), which creates a non-adherent, impermeable barrier to prevent air entry. The site is then covered with a sterile gauze pad and secured with tape.
Following the procedure, the patient is closely observed for any signs of respiratory distress, such as sudden shortness of breath or a change in vital signs, which could indicate a complication like a recurrent pneumothorax. A follow-up chest X-ray is standard practice, typically performed within two to four hours after removal, to confirm that the lung has remained fully expanded and that no new fluid or air accumulation has occurred.
Recovery and Safety Signs at Home
For the days following chest tube removal, the patient is advised on proper wound care to promote healing and prevent infection. The initial occlusive dressing is usually kept in place for 48 to 72 hours. After this time, the wound is inspected and may be left open to air if there is no further drainage. Patients can typically shower 24 hours after removal, but must avoid soaking the site (such as bathing or swimming) until the incision is completely healed.
It is normal to experience localized soreness or discomfort, which can be managed with over-the-counter or prescribed pain relievers. Patients must be vigilant for urgent warning signs that require immediate medical attention. These include:
- Sudden, worsening shortness of breath or severe chest pain.
- Signs of infection at the wound site, such as increased redness, swelling, warmth, or any pus-like drainage.
- A fever above 101.5°F.
- Bright red blood soaking through the bandage.
Following all discharge instructions and attending follow-up appointments are important steps for ensuring a complete and safe recovery.