Chest Tube Discontinuance

[Matthew Reeds]

Pret,

 

As has been said already, it depends upon what it is for and from hospital
to hospital (or even clinician to clinician.) My practice (if this helps):-

 

If it is for a pneumothorax - as soon as the lung has reinflated and there
is no air leak visible (I also look at the CXR to make sure the lung has
completely re-inflated or at least nearly.) I would add that I have a higher
threshold for inserting chest drains in the first place than I used to as I
feel that these are quite often over utilised. If a patient has a minimal
pneumothorax, not respiratory compromised and is not going to require IPPV,
I tend not to insert one but will be acutely aware of the potential need to
place one at any time (should the patient's respiratory system deteriorate)
and be ready to insert one if the need arises.

 

Haemothorax/pleural effusion - once it has completely drained (or at least
has very minimal residual fluid left in the hemi-thorax.) I would still
insert a drain in this instance (even for minimal haemothorax) so as to
prevent a retained clot forming (not a particular problem in itself) which
is however likely to become infected and developing into an empyema which
then usually becomes chronic with the potential for fistulae (the problem.)

 

Empyema - again, once there is minimal drainage they can be removed but
usually (from my experience anyway) these patients have multiple ICDs and
require prolonged drainage. In the UK these patients are under the care
of/receive input from Thoracic Surgeons who make decisions regarding these
ICDs (usually on a daily basis.)

 

Prolonged air leaks - my experience is that these patients usually go home
with single (more frequently multiple) drains in situ on flutter bags and
have them shortened as an outpatient (for eventual removal) after serial
CXRs in the Thoracic Surgery clinic.

 

Evaluation for recurrent collapse - history (patients' symptoms and sudden
onset SOB etc.), examination (breath sounds, dull, hyperresonance etc,) and,
so long as it is not an obvious pre-morbid tensioned pneumothorax, CXR.

 

Hope this helps.

 

Regards,

 

 

Matthew

Surgery UK 

 

 

-----Original Message-----
From: Pret Bjorn [mailto:p.bjorn at netzero.net] 
Sent: 28 August 2007 11:12
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