Chest Tube Management

Following trauma, chest tubes are most commonly inserted for Pneumothorax or Hemothorax.  Here are some tips for their follow-up management:

• They are placed on 20 cm suction for 24 hours
• Patients receive daily chest x-rays to evaluate for recurrent pneumothorax or residual hemothorax
• Every day, the system should be checked for leaks, and the patient assessed for an air leak
• Air leak is assessed by removing the tube from suction and asking the patient to cough - watch the pleurevac for air bubbles
• If there is an air leak, or a pneumothorax on CXR, the tube is placed back to suction
• If there is no air leak, the tube may be placed on water seal (no suction) and a repeat CXR obtained
• The output should be recorded on a daily basis - it is best if the resident who is following the patient makes their own mark on the pleurevac to insure consistency in recording
• When the output is less than 100 ml/24h AND the chest tube has been on water seal, the tube may be discontinued
• When removing a chest tube, there should be two pairs of hands involved
• Repeat the CXR after removal to ensure there is no residual pneumothorax

An article about basics of chest tube mangement is:
Thorac Surg Clin 20 (2010) 399–405

Thanks to Marie Ziesat, MD for providing the article