Chest tube discontinuation

[Wolfer, Rebecca]

When to remove depends on what they are  in for. PTX, when air leak stops. Empyema I like to have minimal drainage, esp if it was extremely contaminated. If there is a residual space I will send them home with the tube until space contracts. Hemothorax I like under 100 cc or so a day, esp if it is turning serosangiounous. 
If it is serous type effusion I will sometimes pull if under 200. anything transudative will usually reabsorb if it collects. the problem with hemothorax is it may; become a fibrothorax and result in lung restriction. broken ribs will often ooze for a few days. There is no "right answer" and I have found that each case can be different and sometimes you just have to bite the bullet. Leaving a tube in can also result in problems.  I also put my to water seal early.  Studies now show that air leak size and duration  are DECREASED with water seal instead of suction. Cerfalio (sp) is a thoracic surgeon out of UAB and has written extensively on it.  Most of us thoracic surgeons use very early water seal on CT.
RW

________________________________

From: trauma-list-bounces at trauma.org on behalf of Pret Bjorn
Sent: Tue 8/28/2007 6:11 AM
To: 'Trauma & Critical Care mailing list'
Subject: Chest tube discontinuation



Looking for protocols or best practices following the discontinuation of
thoracostomy tubes.  How do you monitor for recurrent collapse?



Observe x hours?  Delayed CXR?  Case by case?





Pret Bjorn, RN

Bangor, ME USA

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