pulling a chest tube

[triathlete411]

Up until now I have always been told that when you pull a chest tube you should do it as quickly as possible with one swift jerk that usually causes a lot of pain for the patient.

Now, an older surgeon (~70) at another institution told me that you should pull a chest tube slowly and steadily, while keeping the hole covered as best as you can. He said this doesn't cause as much pain and avoids creating a pneumothorax just as well as the "jerk method."

Is he right? Have I been causing grown men to cry for no reason?

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[droliver]

having had to review this for m&m recently.....

A number of studies show equivalent outcomes for a variety of techniques for tube removal (inspiration vs. expiration, water seal trials vs. continuous suction). I have never seen or heard of reference to slow removal of tubes (doesn't mean it doesn't exist somewhere) ,& brisk removal of chest tubes in this context seems to have an almost universal clinical preference. It seems kind of intuitive that you might have more probs. with slow removal in terms of sucking air in.

As far as hurting less.... I don't know. The only tubes in the chest I've removed gradually are empyema tubes & those can hurt each time they get cracked back. Also if you've ever removed an abdominal drain, it seems like doing it slow seems to prolong the agony vs the "short,sharp,shock" when you do it fairly quickly

 

[womansurg]

I tend to follow the quick, smooth pull method as well. I can't say that folks seem to complain about the removal; usually they say, 'O, is it out? That wasn't bad at all...'

I had different teachings regarding the max inspiration vs max expiration as an intern, and it's true that data yields no different outcome, but one senior surgeon gave me an explanation that I liked and have stuck with. He said that the point is to not allow movement of the pleural space - movement which could contribute to creation of an air pocket, aka pneumothorax. With max inspiration, the natural tendency of a surprised patient to *gasp* on removal of the tube is negated: their lungs are already full to capacity and so little or no pleural movement occurs if they 'forget' your advice and suck air while you pull. If they are on max expiration, on the other hand, they could cause significant movement of their chest wall, perhaps resulting in air being pulled in to the potential space of the pleural cavity. Viola - pneumothorax.

 

[droliver]

like womansurg, I'm a max. inspiration/water seal trial fan myself. If for no other reason then some surgeons I really respect prefer it. There are very rational physiologic arguments for both inspiration & expiration removal & again they perform about the same when studied