6.8 Assisting With Chest Tube Removal
The removal of a chest tube is performed by a health care provider such as a physician, physician’s assistant, or nurse practitioner.
Indications for chest tube removal include the following[1]:
- Improved respiratory status
- Symmetrical rise and fall of the chest
- Bilateral breath sounds
- Decreased chest tube drainage
- Absence of bubbling in the water seal chamber during expiration
- Improved chest X-ray findings
Nursing Responsibilities
The information below summarizes nursing responsibilities before, during, and after the procedure. Expected outcomes after completing the procedure include re-expansion of the lung, client comfort, and healing of the chest tube insertion site without complications, such as infection.
Pre-Removal
- Prepare the client for removal of the chest tube:
- Assess the need for analgesia.
- Obtain required medication orders.
- Instruct the client about the chest tube removal process and inform them that they may have to take a deep breath and hold when it is removed (Valsalva maneuver) to prevent air from reentering the pleural space.
- Assess the client’s lungs for re-expansion:
- Report the most recent chest X-ray results to the health care provider.
- Examine the trend in the water seal fluctuation over the last 24 hours.
- Note if bubbling is present.
- Confirm decrease in drainage.
- Assess the client’s understanding of the chest tube removal process.
- Do not clamp the tube before the removal.
- Administer prescribed pain medication 30 minutes before the procedure, if applicable.
- Identify the client using two patient identifiers as part of the “time out” process as the procedure begins.
During the Procedure
- Assess the client’s level of comfort throughout the procedure.
- Perform hand hygiene and apply PPE, including gloves and face shield if needed.
- Assist the client to a seated, supine, or side-lying position (on the side without the chest tube). Apply a protective fluid impermeable pad under the chest tube.
- Provide physical and emotional support to the client during the procedure, especially as the provider removes dressings and sutures.
- After the health care provider removes the chest tube, applies a sterile occlusive dressing, and secures it, assist the client to an upright position supported with pillows.
- Remove equipment and dispose of supplies appropriately.
- Remove gloves and perform hand hygiene.
After the Procedure
- Auscultate lung sounds.
- Inspect and palpate over the area where the tube was inserted to detect any subcutaneous emphysema.
- Evaluate for any signs of respiratory distress immediately after removal and during the first hours after it is removed. Notify the health care provider if respiratory distress occurs.
- Evaluate vital signs, including oxygen saturation, respiratory status, pain assessment, and level of anxiety.
- Review post-removal chest X-ray and report to the health care provider.
- After removal of a chest tube drainage system, assess the client at a minimum of every 15 minutes for at least an hour, according to agency policy. After the client is stable, monitoring may be less frequent.
- Frequently monitor the chest dressing for drainage. Change the dressing as prescribed, identifying any indications of infection or nonhealing at the insertion site.
- Bauman, M., & Handley, C. (2011). Chest-tube care: The more you know, the easier it gets. American Nurse Today, 6(9), 27-32. https://www.myamericannurse.com/chest-tube-care-the-more-you-know-the-easier-it-gets-2/ ↵