Definition
It is defined as the removal of chest drainage tube in aseptic manner after full lung expansion has taken place.
Articles
- Suture removal set.
- Dressing set:
- Petrolatum on a gauze piece.
- 4 x 4 gauze dressing
- Clean tray with the following:
- Sterile disposable gloves
- Chest tube clamp
- Povidone-iodine
- Normal saline
- Ether
- Adhesive tape
- Elastic bandage
- Scissors
- Kidney tray.
- Disposable waterproof absorbing pads.
- Chest tube clamps.
Procedure
| Nursing Action | Rationale | |
| 1 | Before procedure 1. Ensure that lung re-expansion is complete by noting the signs: Chest X-ray reveals total lung re-expansion Water seal fluctuation has stopped for 24 hours. Drainage is decreased to less than 50 ml/day Percussion reveals normal resonant note. | Pleural of the expanded lung seals the holes on the internal tip of the chest tube, halting fluctuation in the water seal. This can be expected 2-3days after chest tube insertion. Drainage has been reduced, allowing the lungs to re-expand. Normal percussion sound occurs with re-expansion |
| 2 | Clamp chest tube furor 12-24 hours before removal or as ordered by the physician. Assess changes in vital signs, chest pain, and level of apprehension. | Physician orders tube clamping before removal to assess patient’s tolerance |
| 3 | Explain procedure to patient | Reduces anxiety and promotes patient’s cooperation |
| 4 | During procedure Administer prescribed medication for pain relief about 30 minutes before procedure. | Reduces discomfort and relaxes patient. |
| 5 | Assist patient to sit on edge of bed or to lie on the unattached side. | Physician prescribes patient’s position to facilitate tube removal |
| 6 | Support patient physically and emotionally while physician removes dressing and clips or sutures. | Reduces anxiety and promotes cooperation |
| 7 | Physician prepares an occlusive dressing of petroleum gauze on a pressure dressing and sets it aside on a sterile field. | Essential to prepare in advance for quick application to the wound upon tube withdrawal |
| 8 | Tell the patient to take a deep breath and hold it or exhale completely and hold it. | Prevents air from being sucked into chest as the tube is removed. |
| 9 | Physician quickly pulls out the chest tube while patient is holding his breath. | Prevents entry of air through the chest wound. |
| 10 | Quickly apply prepared dressing over the wound and firmly secure it in position with elastic bandage. | Keeps wound aseptic. Prevents entry of air into the chest. Wound closure occurs spontaneously Clips or sutures aid in skin closure. |
| 11 | Assist patient to a comfortable position. | Assures that the patient is comfortable. |
| 12 | After procedure Remove used equipment from bedside with gloved hands. | Prevents spread of microorganisms. |
| 13 | Remove gloves and wash hands | Reduces transmission of microorganisms |
| 14 | Observe patient for subcutaneous emphysema or respiratory distress during the first few hours after the removal | Provides for early notification of physician if adverse symptoms occur. Chest tube may need to be re-inserted. |
| 15 | Assess patient’s vital signs and psychological status | Detects early signs and symptoms of complications. |
| 16 | Check chest dressing for drainage. | Assures occlusion of chest wound. |
| 17 | Record removal of tube, the amount of drainage in the collection bottle, appearance of wound and of dressing and patient’s response. Patient’s response also should include vital signs and respiratory assessment | Documents procedure and status of wound and dressing. Documents patients’ response. |
| 18 | Obtain a chest X-ray if advised by physician |
Follow- up activities
Notify physician immediately of respiratory distress, unstable vital signs, symptoms of subcutaneous emphysema, air leaks, or psychological imbalances if observed.
Special consideration
When viewing chest X-ray immediately after tube removal, the chest tube tract may still be visible.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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