Chest Drain Removal Assessment

[ali]

Hello 99ers,

I have recently encountered a difference of opinion as to the factors that dictate the approach to removal of chest drains. One train of thought is that when there is no bubbling or swinging then clamp leave for a period of time, CXR and blood gas and then remove. Another is to simply clamp, leave for a set period of time and if the infant remains clinically stable then remove. 

Also do you have a set approach of using pig tail or straight as first line use for air leak?

Appreciate thoughts on approach and any evidence to support. TIA.

Many thanks

Alistair

[Stefan Johansson]

Good questions!

We would clamp for a few hours, make an x-ray (always fine if the infant is fine ) and then pull the drain. In a poll, I'd vote for the 2nd option, i.e. pull without x-ray given stable vitals etc.

We have practically switched to pig tail tubings for all infants. I have used three different straight tubes (the clunky old school with troachar, one seldinger variant and the "easydrain"), all did the job but I think pig tail tubes are the most easy ones and still effective usually.

 

[Francesco Cardona]

Very good topic.

I agree with Stefan.

CLAMP -> X-RAY (after a few hours) -> PULL

I would probably adapt the time frame if it was recurrent or there is concern of recurrence or the child is otherwise unstable.

We almost exclusively use pig tail drains at this point. In our opinion they are also more comfortable for the infant and they are placed easily.

Our surgical patients though often have straight tubes.

[roserporta]

What about Clamp ->  LUNG ULTRASOUND --> PULL??    As neonatologists got trainned in performing point of care LUS to abandon the practice of X-Rays is a reality.  I

[ctestolin]

I agree with roserporta.

LUS Is much more sensitive than X-ray for pnx. 

One question: how long do you CLAMP before checking the baby? 6,12,24 hours?

[Dr. Saad Ahmed Seth]

Hi,

Earlier in our unit we used to to clamp CT for 6 hours —-remove and do CXR.

But recently we remove chest tube if pneumothorax resolved and no bubbling without clamping and order CXR after removal.

Most important thing is the baby should be clinically stable…