When should you remove a chest drain? How should a chest drain be removed?

In general, a chest drain can be removed when:

1. The patient’s clinical condition has improved
2. The lung has fully re-expanded on chest imaging
3. There is no air leak (bubbling in the drain) on Valsalva manoeuvre or cough
4. There is minimal fluid drainage:
   • Exact amount depends upon the indication
   • Generally <100-150ml / day
5. Any fluid drained is serous

• Should be removed with the patient either:
  • Performing a Valsalva’s manoeuvre
  • During expiration
• A brisk firm movement should be used
• An assistant should be present to tie the previously placed closure suture
• An X-ray should be performed and reviewed post-removal to assess for pneumothorax