IS CHEST TUBE CLAMPING NECESSARY BEFORE REMOVAL?? AN EXPERIENCE WITH 2661 CASES OF TUBE THORACOSTOMIES

Is Chest Tube Clamping Necessary Before Removal?

Abstract

Objective: The aim of this study was to evaluate outcome of chest tube removal without clamping and relying only on clinical or radiological status for removal.
Study Design: Retrospective descriptive study.
Place and Duration of Study: The study was conducted in CMH Rawalpindi over a period of four years.
Material and Methods: All patients of tube thoracostomies during Jan 2010 to Dec 2013 were included. Sample size was 2661. 1061 intubations were done for trauma, effusions and pneumothoraces, 905 in thoracostomies, 443 in VATS procedures like decortications, apical staplings, pleural biopsies and thymectomies and 252 in miscellaneous procedures such as open pleural biopsies, thoracoplasties and chest wall resections and reconstructions. Chest tube removal was based on absence of air bubbling in chest bottle, clinically or radiologically expanded lung, less than 6 cm excursion of column of chest tube and fluid output of <50ml (pus) and <100ml (clear fluid). It was ensured in all cases that chest tube was not blocked and all tubes were removed by a thoracic surgery trainee. Chest tube was not clamped in any patient before removal to see respiratory distress.
Results: Tube thoracostomies were performed in a vast variety of procedures. 1940 (72.9%) were males and 721 (27.1%) were females. Mean age was 37 years. In 1529 (57.4%) intubation was done on the right side. In 34 (1.27%) there was recurrent fluid collection. Recurrent pneumothorax was seen in 18 (0.67%) while tension pneumothorax was seen in 4 (0.15%). Collective complication rate was in 56 (2.1%). There was no mortality.
Conclusion: Current worldwide practice of clamping chest tube before removal to judge respiratory distress can be challenged by our study. Emphasis is laid on clinical judgment, absence of air leak and minimal excursion sign of well expanded lung before removal of chest tube.