Nursing care
Chest tube removal: readiness, breath-hold, occlusive dressing and post-removal checks
Written and reviewed by Aaliyah Jackson, MSN, RN, CCRN · 4 min read · Updated October 2026
Short answer
Before a provider removes a chest tube, the nurse confirms readiness signs, gives prescribed analgesia ahead of time and teaches the breath-hold the provider will ask for. A sterile occlusive dressing is applied as the tube comes out. Afterward the nurse checks breath sounds, oxygen saturation, subcutaneous emphysema and the dressing, and reports respiratory distress at once.
Signs the client is ready for removal
A health care provider removes the chest tube; the nurse prepares the client, assists and monitors afterward. Readiness signs include improved respiratory status, symmetrical chest rise, bilateral breath sounds, decreasing drainage, no bubbling in the water seal chamber on expiration, and a chest X-ray showing the lung has re-expanded. Report the latest X-ray result to the provider.
Review the trend in water seal fluctuation and any bubbling over recent hours rather than a single look. Do not clamp the tube before removal unless the provider orders it, because clamping a draining system can let air build up in the pleural space. Confirm which drain is being removed when a client has more than one.
Pain control and teaching before the procedure
Removal is uncomfortable, so assess the need for analgesia and obtain orders in advance. Give prescribed pain medication ahead of time so it is working when the tube comes out, following the timing on the order or local protocol. Explain each step, including the brief pulling sensation, and check that the client understands what they will be asked to do.
The provider will ask the client to hold their breath at the moment of removal so air does not enter the pleural space through the tract. Protocols differ: some ask the client to take a deep breath and bear down, others to exhale fully and hold. Teach whichever technique your provider and local protocol specify, and rehearse it before starting.
During removal: positioning and the occlusive dressing
Complete a time out with two identifiers. Help the client into the position the provider requests, often seated or lying on the side without the tube, and place a fluid-impermeable pad under the site. Offer reassurance as the dressing and sutures are removed, and assess comfort throughout.
On the cue, the client holds their breath and the provider withdraws the tube in one smooth movement, then immediately seals the site with a sterile occlusive dressing. A delay in sealing the site gives air a chance to enter the pleural space. Afterward, help the client into an upright position supported by pillows and dispose of equipment safely.
Recurrent pneumothorax and other complications after removal
Watch closely in the first hours after removal. Recurrent pneumothorax may present as falling oxygen saturation, increased work of breathing, diminished breath sounds or reduced chest movement on the affected side, chest pain, tachycardia and hypotension. Palpate around the site for subcutaneous emphysema, which feels like crackling under the skin.
Consider this hypothetical scenario. An hour after removal, a client becomes short of breath with diminished breath sounds on that side. Options include reinforcing the dressing and rechecking later, encouraging incentive spirometry, or staying with the client, applying oxygen per protocol and notifying the provider urgently. The last is correct, because these are signs of possible recurrent pneumothorax.
Monitoring frequency and documentation
Assess vital signs, oxygen saturation, respiratory effort, pain and anxiety frequently after removal, then less often once the client is stable, according to agency policy. Review the follow-up chest X-ray when it is done per order and report the result. Check the dressing for drainage and change it only as prescribed.
Document the time of removal, who removed the tube, the client's tolerance, the dressing applied, breath sounds, saturation and any subcutaneous emphysema. Bleeding at the site is managed with pressure and an occlusive dressing while the provider is notified. Later, the insertion site is assessed for infection and healing until it closes.
Sources and further reading
Open RN Nursing Advanced Skills: Assisting With Chest Tube Removal. Readiness criteria, analgesia before removal, deep breath and hold (Valsalva) teaching, no clamping, sterile occlusive dressing, post-removal lung sounds, subcutaneous emphysema, respiratory distress and X-ray review.
The Royal Children's Hospital Melbourne: Chest drain management nursing guideline. Exhale and hold during removal, quick occlusive seal, post-removal CXR and vital-sign monitoring, signs of pneumothorax, bleeding management, clamping risk.
The next step on this is the same as on everything else here: answer questions and read the rationales. Our respiratory practice questions are the closest set to what this page covers.
Common questions
Does the nurse remove the chest tube?
Removal is performed by a health care provider such as a physician, physician assistant or nurse practitioner. The nurse prepares the client, gives prescribed analgesia, assists during removal and monitors afterward.
Should a chest tube be clamped before removal?
Not unless the provider orders it. Clamping a draining system can let air or fluid accumulate in the pleural space, raising the risk of a tension pneumothorax.
What breathing technique is used during chest tube removal?
The client holds their breath at the moment of removal to keep air out of the pleural space. Some protocols use a deep breath and bear down, others a full exhale and hold, so follow the provider's instruction and local protocol.