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SKILL 42 Assisting with Removal of Chest Tube

EQUIPMENT DOCUMENTATION
Gloves, sterile (for physician and nurse) 1. Time of chest tube removal and by whom.
Vaseline gauze
2. Dressing site and its status.
Dressings
Tape, foam 3. How procedure tolerated.
Chest tube clamp 4. Amount of drainage in system (since last recorded).
Suture removal kit or sterile scissors 5. Assessment of child, especially respiratory status.
Sutures (if requested by physician)
6. X ray if ordered.
7. Premedication.
PROCEDURE
1. Prepare child and family. Enhances cooperation and
participation and reduces anxiety and fear.
2. Premedicate as ordered. Decreases discomfort of chest
tube removal.
3. Gather equipment. Promotes organization and effi-
ciency.
4. Assist child to appropriate position.
5. Put on sterile gloves. Reduces transmission of microor-
ganisms.
6. Assist physician as directed.
NOTE: Removal consists of removing the dressing, clip-
ping the sutures, clamping the chest tube, and remov-
ing the chest tube. A sterile occlusive dressing should
be prepared and held ready to place as soon as the
chest tube is removed.

NOTE: During the chest tube removal instruct the

child to take a deep breath and hold it or to hum or
yell loudly. Raises intrathoracic pressure and helps
prevent recollection of air in the pleural cavity.

7. Apply dressing (or assist physician as directed) and tape

securely.
NOTE: Dressing must be airtight. Dressing should not
be removed for 24 hours. If drainage is soaking
through reinforce the dressing.

8. Dispose of equipment properly.

9. Remove gloves. Wash hands. Reduces transmission of
microorganisms.
10. Reevaluate the child’s status regularly. Monitor vital
signs, breath sounds, and respiratory distress, i.e., watch
for signs of shortness of breath, decreased oxygen satu-
ration, chest pain, or pain on inspiration. Monitor condi-
tion of dressing. Identifies problems such as pneumo-
thorax or mediastinal shift following chest tube removal.
11. Assist in obtaining chest X ray as ordered.

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