Chest Tube Removal, Assisting the Physician 

Purpose: 

• To maintain sterility and prevent infection secondary to the procedure. 

• To provide reassurance and maintain resident comfort. 

Equipment: 

• Suture removal kit 

• Sterile 4x4 gauze pads 

• Impervious drape to protect the bed from drainage 

• Sterile gloves 

• Petrolatum dressing 

• Air-occlusive tape 

Procedure: 

6. Resident Preparation: 

• Instruct the resident in the Valsalva maneuver so that they can hold their breath and bear down as the physician removes the tube. This will increase the intrathoracic pressure, thereby lessening the potential for air to enter the pleural space. 

• Administer pain medication as ordered. 

7. Dressing Preparation: 

• Prior to the chest tube removal, prepare the sterile dressing using aseptic technique. 

• Open the packages, put on sterile gloves, and place the petrolatum gauze pad onto the sterile 4x4 gauze pad. 

8. Assisting with Removal: 

• Place the impervious drape to protect the bed from drainage. 

• The physician will remove the chest tube and immediately apply the prepared dressing to the insertion site to minimize the potential for air to enter the chest wall. 

9. Securing the Dressing: 

• Tape the dressing in place to seal the site from inrushing air. 

• Cover the entire dressing with wide strips of air-occlusive tape to ensure an airtight seal. 

10. Post-Procedure Care: 

• Monitor the resident for signs of respiratory distress or other complications. 

• Ensure the resident is comfortable and provide reassurance as needed. 

Compliance and Documentation: 

• Adhere to CMS guidelines and Requirements of Participation for Long-Term Care Facilities. 

• Document the procedure, including the resident’s response, in their medical record. 

• Note any observations related to signs of infection or complications. 

• Regularly review and update techniques for assisting with chest tube removal according to the latest clinical best practices and regulatory standards. 

• Provide training to staff on proper procedures for assisting with chest tube removal to ensure resident safety and comfort. 

• Conduct regular audits to ensure compliance with this policy and address any gaps in practice or documentation. 

References: 

• Centers for Medicare & Medicaid Services (CMS). State Operations Manual (SOM), Appendix PP - Guidance to Surveyors for Long-Term Care Facilities. 

• CMS Requirements of Participation for Nursing Homes.