Step 13: How to remove

•The chest tube should be removed either while the patient performs Valsalva maneuver or during expiration with a brisk firm movement while an assistant ties the previously placed closure suture.

•Obtain an early chest radiograph.

Step 14: Complications

•Local site bleeding

•Hematoma

•Hemothorax from intercostals vessel injury

•The tube misplaced

•The nonfunctional tube

•Laceration of the lung, liver, and heart

•Intra-abdominal placement

•Pneumothorax

•Infection-site cellulitis, track infection, empyema

•Subcutaneous emphysema

•Clamping a chest tube with presence of air leak may result in tension pneumothorax

•Persistent leak at the site of infection and around the tube

Suggested Reading

1.Zgoda MA, Lunn W, Ashiku S, et al. Direct visual guidance for chest tube placement through a single-port thoracoscopy: a novel technique. Chest. 2005;127:1805–7.

A rigid telescope can be safely utilized to accurately place a chest tube after medical thoracoscopy through the same portal used for the pleuroscope.

2.Cerfolio RJ, Bass CS, Pask AH, et al. Predictors and treatment of persistent air leaks. Ann Thorac Surg. 2002;73:1727–30.

Steroid use, male gender, a large leak, a leak with a pneumothorax, and having a lobectomy are all risk factors for a persistent leak. Discharge on a Heimlich valve is safe and effective for patients with a persistent leak unless the leak is an expiratory.

3.Gayer G, Rozenman J, Hoffmann C, et al. CT diagnosis of malpositioned chest tubes. Br J Radiol. 2000;73:786–90.

CT has proved to be extremely accurate in evaluating the position of a chest tube and has often provided additional valuable information with significant therapeutic impact.

4.Luketich JD, Kiss M, Harshey J. Chest tube insertion: a prospective evaluation of pain management. Clin J Pain. 1998;14:152–4.

In this study, a new protocol, including improved house staff, nursing education, premedication, proper insertion techniques, and more liberal and precise delivery of local anesthetics, allowed the goal of a painless chest tube insertion.

5.Gilbert TB, McGrath BJ, Soberman M. Chest tubes: indications, placement, management and complications. J Intensive Care Med. 1993;8:73–86.

A review article on chest tube management.