胸管何時拔除？拔除時應注意何事？

for pneumothorax, the tube is left in place on suction for at least 24 h after all air leaks have stopped

for hemothorax, the tube is left in place until the drainage is serous and less than 200ml/24h


However, if the pt is mechanically ventilated, many physicians prefer to keep the chest tubes in place in cases a new pneumothorax suddenly develops.

When the tube is to be removed, the patient is asked to take a deep breath and bear down, as in a Valsalva maneuver, to produce maximum intrathoracic pressure and lung volume.

The patient should be in full inspiration when the tube is pulled.

拔管當下，以及 12~24 h 之後，都要再照 X-ray 以確認並無 recurrent pneumothorax ，且 lung 有持續的 expansion