a

Chest Tube Removal

my name is Michael McGonagall I'm the

director of the trauma programs at

Regions Hospital and I'm going to give

you a crash course on how to remove a

chest tube before you do this you need

to make sure that the patient is really

ready to have the tube removed and we

look at three things we want to make

sure that they have less than 150 cc's

of drainage over three shifts or 24

hours we want to make sure that they do

not have an active air leak and that

they have either no or a small and

stable residual chemo or pneumothorax

the most important thing is to get

everybody and everything prepared for

this procedure it's important to talk to

the patient and make sure that they

understand what's going to be happening

and at some point as you are doing it

you will ask them to hold their breath

and bear down this makes sure that any

air that is outside the chest can't go

back inside the other thing is to make

sure that you have all of your equipment

set up and I've done this in advance on

this nice field here the things that you

need to do this are obviously your

patient with the chest tube you need to

have a dressing and that will just be

some simple four by fours some people

like to use Vaseline gauze which is fine

and then I like to pre-cut my tape so

that I can put the dressing on as

quickly as possible because this is a

fast procedure so what I like to do

actually is to get my dressing pretty

much ready to go so I'll take the

Vaseline gauze put it right in the

middle of four-by-four I'll take the

first piece of tape and actually put the

gauze onto it so that it is also ready

so now we're all set time to talk to the

patient get them prepared explain the

importance of doing the exhalation

technique if this patient were on a

ventilator you can also get the

respiratory therapists there so that

they can do an inspiratory pause as you

pull the tube as it functions the same

as doing about salva maneuver with the

patient so as you are ready and you've

got everything set there's just one

thing holding this tube in and that is

the stitch so what you can do then is

cut the stitch and once you do that you

have to hold that tube from there on

afterwards until you've got it out

because you do not want it to slip out

unexpectedly take the dressing and get

it ready because this is going to be

something that happens very very quickly

and if you'll notice the stitch is

separated it just sits around the tube

here get the patient ready tell them to

hold their take their deep breath and

hold it bare down and then as you pull

the tube you're actually putting the

dressing in place and pull out very very

quickly put the tube in some nice safe

area because it will be contaminated

with blood and then put the dressing on

it now you've got your other pre-cut

pieces of tape all set so you can take

those and very quickly put those over

the dressing typical instructions for

care of this wound are leave the

dressing on for 48 hours if the patient

is going to be going home you tell them

keep it dry do not get it wet in a bath

or shower for that first 48 hours

afterwards they can take the dressing

off and they can replace it with a

simple band-aid they are able to shower

or bathe or swim whatever they wish to

do at that point and they should have a

follow-up visit scheduled within about a

week to two weeks so that the surgeon

who placed it can have a look at the

wound to make sure it's healing up as

expected they should also be told if

they see any increasing redness if they

experience any pain that they should

call right away and let the surgeon know

so they can determine if the patient

needs to be seen sooner that's it that's

a crash course in how to remove a chest

tube