Is a Chest Radiograph Required After Removal of Chest Tubes in Children?

Ellen McGrath, PNP; Lee Ranstrom, PNP; Debra Lajoie, PhD, RN; Lauren McGlynn, PNP; David Mooney, MD, MPH

Disclosures

J Pediatr Health Care. 2017;31(5):588-593. 

In This Article

Background

Chest tubes are a routine part of postoperative care for children undergoing many types of thoracic procedures. There are various indications for chest tube placement after surgery, but they are often used for drainage of pleural fluid or evacuation of air or potential air leaks. During removal of the chest tube, it is possible for air to be entrained into the pleural space, for a new air leak to occur, or for fluid to collect in the pleural space. Each of these possible complications of chest tube removal can cause respiratory compromise and necessitate intervention.

At the Surgical Service at Boston Children's Hospital, chest tubes are most often removed at the bedside by the general surgery nurse practitioner or resident using a standard chest tube removal protocol unless otherwise specified. Historically, a postremoval film was obtained shortly after chest tube removal to rule out any complications.

With the current push for safety and cost containment in health care, practitioners rely on evidence-based medicine to help determine the need for laboratory and/or diagnostic studies in various clinical scenarios (Finkler & Ward, 2003). Working with pediatric patients increases concern regarding the long-term effects of radiation exposure, making it important to ensure the necessity of all radiographic studies performed. In our clinical practice, we noticed that many postremoval films showed no clinically significant findings. The purpose of this study was to determine if a postremoval film was clinically necessary.

"In our clinical practice, we noticed that many postremoval films showed no clinically significant findings."

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