What technique should be used during chest tube removal to prevent air entry?

• A. Have the patient exhale fully or perform Valsalva during removal; apply an airtight occlusive dressing immediately afterward.
• B. Instruct patient to hold breath during removal.
• C. Remove quickly without bearing down.
• D. Leave the dressing open to air.

Answer: (A)

The key idea is to prevent air from entering the pleural space at the moment the tube is removed. Pushing up pressure in the chest during withdrawal reduces the chance that air will be sucked into the chest. Having the patient exhale fully or perform a Valsalva maneuver as the tube comes out creates that temporary seal. Immediately afterward, apply an airtight occlusive dressing to maintain the seal and prevent any air from leaking back in. If you don’t bear down or if the dressing is left open, air can rush into the pleural space and a pneumothorax can develop. After removal, monitor for signs of pneumothorax and keep the dressing secure.