Chest Tube Management

Introduction to Chest Tube Securement

The chest drain must be well secured after insertion using a non-absorbable suture to narrow the linear incision around the edge of the chest drain, followed by a stay suture placed through the skin and then criss-crossed up the drain to prevent accidental dislodgment 1
Initial incision closure should use a non-absorbable suture to narrow the linear incision around the edge of the chest tube 1
A stay suture method, where a suture is placed through the skin and then criss-crossed up the drain in a "Roman sandal" pattern, can help prevent accidental dislodgment 1

Commercial devices designed specifically for chest tube securement can be used 1
Adhesive options, such as Steristrips, transparent adhesive dressings, and "Omental tag" of tape, can provide additional security 1
For COVID-19 patients, consider additional securement methods to minimize the risk of accidental disconnection, such as using disposable inner cannulas, Xeroform dressings, custom tubes with stoma seals, or Silflex silicone pads 3

Connect the tube to a unidirectional flow drainage system (underwater seal bottle) and ensure the drainage system remains below the level of the patient's chest at all times 1
Perform a chest radiograph after insertion to confirm proper tube position 1, 2
Avoid excessive tape, as it may restrict chest wall movement and increase moisture collection 1
Prevent tube kinking by using proper positioning techniques to prevent obstruction of drainage 1
Regularly inspect the insertion site using transparent dressings 1
Never clamp a bubbling chest tube, as it can lead to tension pneumothorax 4
Use a staged approach when removing chest tubes to ensure air leaks have resolved 4

Some guidelines note that purse string sutures should not be used, as they convert a linear wound to a circular one and may cause more pain and leave an unsightly scar 1
However, some clinicians believe purse string sutures provide the best security for a drain 1