Chest tube nursing: the 200 mL/hour hemorrhage rule

Chest tube therapy is one of the highest-stakes nursing responsibilities in acute and critical care. The device is simple – a flexible tube placed through the thoracic wall into the pleural space – but the nursing demands are not. Every nurse caring for a patient with a chest tube must understand why it is there, how the drainage system works, what normal looks like, and what signs demand an immediate response. NCLEX tests chest tubes extensively, and clinical practice offers almost no margin for error.

This guide covers indications, three-chamber mechanics, drainage assessment, nursing priorities, troubleshooting, and removal – with a focused set of high-yield NCLEX discriminators at the end.

Indications

A chest tube (also called a thoracostomy tube or tube thoracostomy) is inserted to drain air, fluid, or both from the pleural space. The normal pleural space contains only a few milliliters of lubricating fluid; any abnormal accumulation impairs lung expansion and can compromise hemodynamics.

Tube size matters, and the trend is toward smaller tubes. Drain size is measured in French (1 Fr = 1/3 mm), and the 2023 BTS pleural procedures statement calls a drain small-bore at 14 Fr or less. Small-bore drains, usually placed over a guidewire (Seldinger technique), are enough for most spontaneous and iatrogenic pneumothoraces and for many effusions and infections. Large-bore tubes are still customary for unstable trauma patients and large air leaks. For traumatic hemothorax, 28–32 Fr is the usual size, but in stable patients a multicenter randomized trial found 14 Fr percutaneous catheters as effective as 28–32 Fr tubes (Kulvatunyou et al., 2021). Small-bore drains block more easily, so BTS advises regular saline flushes (30 mL every 6–8 hours) when ordered. Post-cardiac surgery patients often have two mediastinal tubes.

Water-seal chamber mechanics

The water-seal drainage system is the most heavily tested aspect of chest tube nursing. Understanding the physics prevents errors and makes NCLEX questions straightforward.

The three-chamber system

Modern chest drainage systems (Pleur-evac and equivalents) consolidate three functional chambers into a single disposable unit. Understanding each chamber individually is essential.

Chamber 1 – collection chamber. This is the right-most chamber where drainage collects. It is graduated in milliliters so you can measure output precisely. Fluid drains here by gravity from the pleural space and stays separate from the other two chambers. You document the drainage level at regular intervals and mark it with a pen or tape.

Chamber 2 – water-seal chamber. This is the heart of the system. It contains approximately 2 cm of sterile water that acts as a one-way valve: air and fluid can leave the pleural space (bubbling up through the water and escaping), but outside air cannot travel backward into the chest. This directional seal is what prevents atmospheric pressure from collapsing the lung.

The water-seal chamber produces two observable phenomena that every nurse must interpret correctly:

• Tidaling (fluctuation): The water level in the water-seal chamber rises on inspiration and falls on expiration in a spontaneously breathing patient – the reverse in a mechanically ventilated patient. This fluctuation reflects changes in intrapleural pressure with each breath. Tidaling tells you the tube is patent and connected to the pleural space. It is normal and expected.

• Bubbling: Intermittent bubbling on expiration or coughing is expected while air drains from a pneumothorax. As the lung heals, bubbling diminishes and stops. Continuous, vigorous, unremitting bubbling throughout the respiratory cycle is abnormal – it indicates an air leak somewhere in the system, either at the tube insertion site, at a connection point, or within the lung itself. Trace the system from patient to collection unit to find the source.

Chamber 3 – suction control chamber. This chamber limits suction to a safe level regardless of how much suction the wall unit applies. It contains water (typically enough to produce −20 cmH₂O of suction) and a vent to atmosphere. When wall suction is active, you should see gentle, continuous, quiet bubbling in this chamber – that is correct function. Vigorous, noisy bubbling in the suction control chamber does not produce more suction; it wastes energy and causes unnecessary turbulence. Reduce wall suction until bubbling is gentle.

Many units now use dry suction systems, where a dial sets the suction level and a float or bellows indicator confirms suction is working. There is no bubbling in a dry suction control chamber, so do not “fix” its absence by turning up the wall suction.

Suction is not automatic. The 2023 BTS pleural procedures statement advises against routine suction because no clinical benefit has been shown, and against suction soon after insertion because rapid re-expansion can cause re-expansion pulmonary edema. When suction is used, the provider prescribes the pressure (−20 cmH₂O is a common setting, and BTS recommends low-pressure, high-volume suction). If suction is not ordered, gravity drainage alone (“water seal only” mode) is appropriate – disconnect from wall suction but leave the suction port open to atmosphere.

Clamping: when and never

Clamping stops airflow and drainage through the tube. This is occasionally necessary – and occasionally catastrophic.

You DO clamp (briefly, per protocol or order) when:

• Changing a broken or contaminated drainage system (clamp briefly, swap, unclamp immediately)
• Locating an air leak. Start at the dressing and clamp the tubing momentarily while watching the water-seal chamber. If the bubbling stops, the leak is at the insertion site or inside the patient’s chest – unclamp, reinforce the dressing, and notify the provider. If the bubbling continues, the leak is between the clamp and the drainage unit: move the clamp down the tubing in steps until the bubbling stops to find the leaking section or connection. If it still bubbles with the clamp next to the unit, the unit itself is leaking and must be replaced (Open RN Nursing Advanced Skills, 2023)
• Draining a large pleural effusion when the patient develops repetitive coughing or chest pain. BTS 2023 advises prompt clamping, regardless of the volume drained, because these symptoms can herald re-expansion pulmonary edema. The order should specify how much fluid may drain and when to clamp and unclamp
• Ordered by the provider for a specific reason

You NEVER clamp for:

• Tension pneumothorax – clamping with active air accumulation traps pressure in the chest and is fatal
• A bubbling drain, outside of the brief leak check above. BTS 2023 says clamping a bubbling chest tube should be avoided unless under specialist pleural supervision in specific circumstances
• Ambulation or transport without explicit provider order to clamp
• Routine position changes

The rule: When in doubt, do not clamp. An open tube that drains freely cannot cause tension pneumothorax. A clamped tube with ongoing air leak can kill the patient within minutes.

Drainage assessment

Systematic, documented assessment of chest tube output is a core nursing responsibility – hourly in the immediate post-operative, post-trauma, or post-insertion period, and at least every shift once stable. BTS 2023 recommends a dedicated chest drain chart recording drainage volume, swinging (tidaling), bubbling, and the insertion site at least daily.

Drainage characteristics

Volume thresholds

Expected output depends on why the tube was placed, so use the notification parameters in the provider’s order and watch the trend: output should fall and lighten in color over time. The key threshold to know for NCLEX and clinical practice:

Greater than 200 mL per hour of bright red drainage = active hemorrhage. Notify the provider immediately. This is the threshold that triggers urgent evaluation – potential return to the OR, massive transfusion activation, or autotransfusion (collecting shed blood and re-infusing it via an autotransfusion system). In trauma, ATLS teaches that about 1,500 mL of blood on tube insertion, or continued output of about 200 mL per hour for 2–4 hours, should prompt consideration of surgical exploration.

Clot formation and tube patency

Blood in the collection chamber can clot and obstruct drainage. Stripping or milking the chest tube – squeezing the tubing to manually advance clots – was historically common but is now discouraged. A review of the evidence after cardiac surgery concluded that, because of possible tissue damage and no demonstrable benefit, most patients should not have their drains stripped or milked (Day et al., 2008). Some cardiac surgery protocols still permit “gentle milking” of mediastinal tubes; follow the specific facility protocol.

Monitor for clot formation by tracking output trends: a sudden stop in drainage from a previously draining tube warrants assessment for tube kinking, clot, or lung re-expansion. BTS 2023 notes that loss of swinging is usually a sign of drain blockage, which a saline flush often clears when one is ordered.

Nursing priorities

Positioning

The patient should be in semi-Fowler’s position (30–45 degrees) unless contraindicated. This position promotes lung expansion and allows fluid to drain by gravity. Patients can be repositioned and ambulated with a chest tube in place, provided the drainage system stays below chest level and remains upright throughout.

Tubing management

Poor tubing management is the most common preventable complication at the bedside. Follow these principles without exception:

• No dependent loops. Loops in the tubing create a fluid trap that generates back-pressure and impairs drainage. Keep tubing in a straight or gently coiled path from the patient to the collection unit.
• No kinking. Kinked tubing stops drainage and can cause pressure buildup. Secure tubing loosely to the bed linen, not the side rail – the rail moves independently and will kink the line.
• No tension on the insertion site. A pull on the tube can dislodge it or cause pain. Leave some slack between the dressing and the point where the tubing is anchored. BTS 2023 states that all chest drains should be fixed with a holding suture to prevent fall-out.
• The drainage system must always sit below the level of the chest and stay upright. If the collection unit rises above the insertion site, drainage reverses back into the pleural space. This applies at all times: at rest, during transport, during transfers. Keep enough water in the seal to cover the end of the tube.

Insertion site and dressing

An occlusive dressing covers the insertion site at all times. For a closed tube thoracostomy (standard clinical placement), a four-sided occlusive dressing is used – sealed on all four edges. For an open pneumothorax (sucking chest wound from penetrating trauma), a three-sided occlusive dressing is applied: three edges sealed, one edge open. The open edge acts as a flutter valve – sealed on inspiration to prevent air entry, open on expiration to allow air escape.

Inspect the insertion site with each dressing change or at minimum every shift:

• Assess for subcutaneous emphysema (crepitus on palpation – tissue feels like bubble wrap)
• Inspect for signs of infection (erythema, warmth, purulent drainage, fever)
• Confirm sutures are intact
• Note any tube migration (mark the tube at skin level during initial placement)

Monitoring for complications

Tension pneumothorax is the most immediately life-threatening complication associated with chest tube management. It occurs when air accumulates in the pleural space faster than it escapes – often when a tube becomes obstructed or clamped inappropriately.

Classic triad: tracheal deviation away from the affected side + absent breath sounds on the affected side + hypotension (obstructive shock from mediastinal shift compressing the heart and great vessels). Distended neck veins (JVD) are also present when the patient is not also hypovolemic. Tracheal deviation is a late sign, so do not wait for it.

The presentation depends on whether the patient is breathing on their own. In a systematic review of 183 reported cases, hypoxia was present in 50% of patients breathing unassisted versus 92% of those on assisted ventilation, and ventilated patients had 12.6 times the adjusted odds of hypotension. Most ventilated patients who became hypotensive or arrested did so within minutes of presentation (Roberts et al., 2015).

Response: Do NOT clamp the tube. Release any occlusive seal or clamp. Notify the provider immediately. Prepare for emergency decompression. In adults, ATLS (10th edition) moved the needle decompression site to the 4th or 5th intercostal space, just anterior to the midaxillary line, because at the traditional 2nd intercostal space, midclavicular line, a standard catheter often fails to reach the pleural space. The 2nd intercostal space at the midclavicular line remains the site in children. In the hospital, finger thoracostomy and a new or repositioned chest tube are the definitive response. This is a minutes-to-death emergency. See the pneumothorax nursing guide for more detail.

For patients on mechanical ventilation, peak and plateau airway pressures rise and oxygenation deteriorates – monitor both vigilantly in mechanically ventilated patients with chest tubes.

Troubleshooting

System dropped or broken

If the collection unit is dropped and the water seal is disrupted, submerge the distal end of the chest tube in 2 cm of sterile water immediately to re-establish the seal while a replacement unit is obtained. A cup of sterile water or saline at the bedside is standard in many ICUs for this reason. Never leave the tube open to air for more than a few seconds.

Continuous bubbling throughout the respiratory cycle

This indicates an air leak. Systematically trace from patient to system:

1. Inspect the dressing and insertion site – is air escaping at the skin?
2. Check all connections along the tubing – are they tight and taped?
3. Check the collection unit for cracks
4. If all connections are intact and the leak persists, the source is within the lung itself (bronchopleural fistula or persistent parenchymal leak) – document and notify the provider

No tidaling

Absence of the expected rise-and-fall in the water-seal chamber has two possible causes – one reassuring, one requiring intervention:

• Lung re-expanded: The most desirable explanation. Confirm with chest X-ray. If the lung is fully re-expanded, the tube may be ready for removal.
• Tube kinked, clamped, or clogged: The tube has lost patency. Inspect the full length of the tubing for kinks, loops, or clots. A tube with no tidaling AND continued respiratory distress is kinked or blocked until proven otherwise. BTS 2023 notes that blockage is the usual cause of lost swinging and that a saline flush often clears it, so ask whether a flush is ordered.

Subcutaneous emphysema

Air tracked into the subcutaneous tissues presents as crepitus – a crackling sensation on palpation around the insertion site and potentially spreading toward the face, neck, or chest wall. Mild subcutaneous emphysema is common after chest tube insertion for pneumothorax and is usually of little clinical consequence. Rapid spread, however, indicates ongoing air leak with inadequate drainage – BTS 2023 lists drain blockage and a poorly placed or migrated drain (side holes slipping out into the subcutaneous tissue) as risk factors. Check the tube for blockage and migration, notify the provider, and apply suction only as ordered.

Patients with pneumothorax already present with subcutaneous emphysema in some cases, particularly after traumatic injury.

Hemothorax and hemorrhagic shock risk

Large-volume hemothorax can precipitate hemorrhagic shock. Any patient draining bright red blood at a significant rate warrants a concurrent IV access assessment (large-bore IV secured), blood type and crossmatch confirmation, and heightened hemodynamic monitoring. For management of thoracic and pleural fluid conditions, including malignant effusion and parapneumonic processes, see the pleural effusion nursing guide.

Chest tube removal

Criteria for removal

The provider decides when the tube comes out, and the criteria depend on why it was placed. Typical criteria:

• Lung re-expansion confirmed on chest X-ray (CXR)
• No air leak (water-seal chamber shows no bubbling, including when the patient coughs), commonly for about 24 hours
• Fluid output below the provider’s threshold. Thresholds vary widely. Older protocols used 50–100 mL per 24 hours, but a randomized study found 200 mL per day of non-infected drainage a safe threshold (Younes et al., 2002), and after lung resection tubes have been removed safely with up to 450 mL per day of non-chylous drainage (Cerfolio & Bryant, 2008)
• If suction was used, the patient has been stable on water seal without recurrence

Whether to do a “clamping trial” before removal, to unmask a small air leak, is not standard. BTS 2023 notes that practice varies and that the evidence is retrospective and conflicting.

Removal technique

Chest tube removal is commonly a two-person procedure – one to remove the tube, one to manage the dressing. The patient performs a Valsalva maneuver (takes a breath and bears down) or holds the breath, which raises intrapleural pressure and minimizes air entry as the tube exits. Whether the tube comes out at end-inspiration or end-expiration does not change the rate of post-removal pneumothorax (Bell et al., 2001), and BTS 2023 states timing does not seem to matter as long as a Valsalva maneuver is performed.

Steps:

1. Gather supplies: suture removal kit, occlusive petroleum (Vaseline) gauze, additional gauze, tape
2. Pre-medicate for pain – removal is uncomfortable
3. Remove the anchoring suture (if separate from the purse-string); leave the purse-string in place if present to cinch the site closed on removal
4. Instruct the patient to perform a Valsalva maneuver (or hold the breath)
5. Remove the tube in one steady, continuous pull
6. Immediately occlude the site – petroleum (Vaseline) gauze followed by dry gauze is common – and tie the purse-string suture if present
7. Tape on all four sides (occlusive)
8. Obtain a post-removal CXR if ordered

Post-removal CXR. BTS 2023 says a post-removal radiograph should be considered to check for re-accumulation or pneumothorax, and many protocols order one. A routine film is not always needed: in 400 removals after cardiac surgery, skipping the routine film in patients with no clinical change would have missed only 6 small pneumothoraces, none of which needed treatment, and would have avoided 86% of films (Eisenberg & Khabbaz, 2011). Follow the provider’s order, and request imaging promptly for any new symptoms.

Post-removal monitoring: Assess for recurrent pneumothorax – sudden dyspnea, decreased breath sounds, subcutaneous emphysema, falling SpO₂. Give oxygen to the prescribed SpO₂ target (BTS: 94–98% for most adults, 88–92% for those at risk of hypercapnic respiratory failure). High-flow oxygen to speed reabsorption of a residual pneumothorax is a separate, weaker indication; see the pneumothorax nursing guide.

Assess the site with each dressing change for air escape (palpate for crepitus), wound healing, and signs of infection. The site typically heals within days to weeks depending on the tube size.

NCLEX tips

These are the highest-yield discriminators for chest tube questions:

1. Tidaling (fluctuation in the water-seal chamber) is normal – it means the tube is patent and connected to the pleural space. Tidaling stops when the lung re-expands (good) or when the tube is kinked/clogged (bad). Know the difference: a re-expanded lung on CXR = good; respiratory distress + no tidaling = kinked tube.

2. Continuous bubbling in the water-seal chamber = air leak. Intermittent bubbling on expiration or coughing is expected while a pneumothorax drains in a spontaneously breathing patient. Bubbling that never stops across the entire respiratory cycle is an air leak – trace the system.

3. Gentle, quiet, continuous bubbling in the SUCTION CONTROL chamber = correct suction function. Vigorous bubbling there does not mean more suction – it means the wall suction is too high. Reduce it.

4. NEVER clamp a chest tube for suspected tension pneumothorax. Clamping increases intrapleural pressure and will kill the patient. The correct action is to unclamp or unseal, call for help, and prepare for emergent decompression.

5. The drainage system must always stay below chest level. Elevating the unit reverses drainage back into the pleural space. This applies during patient transport and transfers.

6. >200 mL/hour of bright red drainage = active hemorrhage. Call the provider immediately. Do not wait for the next assessment.

7. Tracheal deviation AWAY from the affected side + absent breath sounds + hypotension = tension pneumothorax. A blocked or wrongly clamped tube can cause it. Treat it as a medical emergency requiring immediate decompression (adult needle site per ATLS 10th edition: 4th or 5th intercostal space, just anterior to the midaxillary line). Tracheal deviation is late, and ventilated patients deteriorate fastest.

8. Subcutaneous emphysema (crepitus around the insertion site, neck, or face) = air has tracked into soft tissue. Mild and localized is expected; rapid spread indicates ongoing air leak or inadequate drainage.

9. Occlusive dressings: Four-sided seal for closed chest tube sites. Three-sided seal for open/penetrating chest wounds (one edge left open to act as a flutter valve).

10. No dependent loops in the tubing. Fluid in a loop creates back-pressure that impairs drainage. Keep tubing straight and below chest level.

11. Stripping and milking chest tubes is not recommended in most settings. The generated negative pressure can injure pleural tissue. Follow institutional protocol – some cardiac surgery units still use gentle milking for mediastinal tubes.

12. If the drainage unit is dropped or broken, immediately submerge the distal end of the tube in sterile water to preserve the water seal while a replacement is obtained. Never leave the tube open to air.

13. Chest tube removal is performed during a Valsalva maneuver or breath hold to minimize air entry at the moment the tube exits the chest. End-inspiration and end-expiration removal have similar pneumothorax rates. The occlusive dressing is applied immediately.

14. Removal criteria: Lung re-expanded on CXR + no air leak + fluid output below the provider’s threshold (thresholds range from 100 to 450 mL/day depending on indication and protocol).

15. Post-removal CXR is obtained per order to check the lung stays expanded. Assess the patient regardless: new dyspnea, falling SpO₂, or subcutaneous emphysema warrants urgent imaging and a call to the provider.

16. Air-leak check: clamp briefly at the dressing. If bubbling stops, the leak is at the insertion site or inside the chest. If bubbling continues, the leak is in the tubing or drainage unit. Unclamp immediately after each check.

References

1. Roberts DJ, Leigh-Smith S, Faris PD, et al. Clinical presentation of patients with tension pneumothorax: a systematic review. Annals of Surgery. 2015;261(6):1068–1078. doi:10.1097/SLA.0000000000001073
2. Roberts ME, Rahman NM, Maskell NA, et al. British Thoracic Society Guideline for pleural disease. Thorax. 2023;78(Suppl 3):s1–s42. doi:10.1136/thorax-2022-219784 (supersedes the 2003 and 2010 BTS chest drain guidance)
3. Rahman NM, Pepperell J, Rehal S, et al. Effect of opioids vs NSAIDs and larger vs smaller chest tube size on pain control and pleurodesis efficacy among patients with malignant pleural effusion: the TIME1 randomized clinical trial. JAMA. 2015;314(24):2641–2653. doi:10.1001/jama.2015.16840
4. Baumann MH, Strange C, Heffner JE, et al. Management of spontaneous pneumothorax: an American College of Chest Physicians Delphi consensus statement. Chest. 2001;119(2):590–602. doi:10.1378/chest.119.2.590
5. Light RW. Pleural Diseases. 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2013.
6. Patrini D, Panagiotopoulos N, Pararajasingham J, Gvinianidze L, Iqbal Y, Lawrence DR. Etiology and management of spontaneous haemothorax. Journal of Thoracic Disease. 2015;7(3):520–526. doi:10.3978/j.issn.2072-1439.2014.12.50
7. Luketich JD, Kiss M, Hershey J, et al. Chest tube insertion: a prospective evaluation of pain management. Clinical Journal of Pain. 1998;14(2):152–154.
8. Johnson KL, ed; American Association of Critical-Care Nurses. AACN Procedure Manual for Progressive and Critical Care. 8th ed. St. Louis, MO: Elsevier; 2024.
9. Mowery NT, Gunter OL, Collier BR, et al. Practice management guidelines for management of hemothorax and occult pneumothorax. Journal of Trauma. 2011;70(2):510–518. doi:10.1097/TA.0b013e31820b5c31
10. Porcel JM. Chest tube drainage of the pleural space: a concise review for pulmonologists. Tuberculosis and Respiratory Diseases. 2018;81(2):106–115. doi:10.4046/trd.2017.0107
11. Harding MM, Kwong J, Hagler D, Reinisch C. Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems. 13th ed. St. Louis, MO: Elsevier; 2026.
12. Potter PA, Perry AG, Stockert PA, Hall AM. Fundamentals of Nursing. 11th ed. St. Louis, MO: Elsevier; 2022.
13. Ignatavicius DD, Rebar CR, Heimgartner NM. Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care. 11th ed. St. Louis, MO: Elsevier; 2024.
14. Hinkle JL, Overbaugh KJ, Cheever KH, Bradley CE. Brunner and Suddarth’s Textbook of Medical-Surgical Nursing. 16th ed. Philadelphia, PA: Wolters Kluwer; 2025.
15. Herdman TH, Kamitsuru S, Takáo Lopes C, eds. NANDA International Nursing Diagnoses: Definitions and Classification 2024–2026. 13th ed. New York, NY: Thieme; 2024.
16. Asciak R, Bedawi EO, Bhatnagar R, et al. British Thoracic Society Clinical Statement on pleural procedures. Thorax. 2023;78(Suppl 3):s43–s68. doi:10.1136/thorax-2022-219371
17. Open Resources for Nursing (Open RN); Ernstmeyer K, Christman E, eds. Nursing Advanced Skills. Chapter 6, Manage chest tube drainage systems. Eau Claire, WI: Chippewa Valley Technical College; 2023. PMID: 37643272
18. Kulvatunyou N, Bauman ZM, Zein Edine SB, et al. The small (14 Fr) percutaneous catheter (P-CAT) versus large (28–32 Fr) open chest tube for traumatic hemothorax: a multicenter randomized clinical trial. Journal of Trauma and Acute Care Surgery. 2021;91(5):809–813. doi:10.1097/TA.0000000000003180
19. American College of Surgeons Committee on Trauma. Advanced Trauma Life Support Student Course Manual. 10th ed. Chicago, IL: American College of Surgeons; 2018. (Adult needle decompression site; hemothorax thresholds for surgical exploration.)
20. Rahman NM, Maskell NA, West A, et al. Intrapleural use of tissue plasminogen activator and DNase in pleural infection. New England Journal of Medicine. 2011;365(6):518–526. doi:10.1056/NEJMoa1012740
21. Day TG, Perring RR, Gofton K. Is manipulation of mediastinal chest drains useful or harmful after cardiac surgery? Interactive CardioVascular and Thoracic Surgery. 2008;7(5):888–890. doi:10.1510/icvts.2008.185413
22. Younes RN, Gross JL, Aguiar S, Haddad FJ, Deheinzelin D. When to remove a chest tube? A randomized study with subsequent prospective consecutive validation. Journal of the American College of Surgeons. 2002;195(5):658–662. doi:10.1016/S1072-7515(02)01332-7
23. Cerfolio RJ, Bryant AS. Results of a prospective algorithm to remove chest tubes after pulmonary resection with high output. Journal of Thoracic and Cardiovascular Surgery. 2008;135(2):269–273. doi:10.1016/j.jtcvs.2007.08.066
24. Bell RL, Ovadia P, Abdullah F, Spector S, Rabinovici R. Chest tube removal: end-inspiration or end-expiration? Journal of Trauma. 2001;50(4):674–677. doi:10.1097/00005373-200104000-00013
25. Eisenberg RL, Khabbaz KR. Are chest radiographs routinely indicated after chest tube removal following cardiac surgery? American Journal of Roentgenology. 2011;197(1):122–124. doi:10.2214/AJR.10.5856
26. O’Driscoll BR, Howard LS, Earis J, Mak V. BTS guideline for oxygen use in adults in healthcare and emergency settings. Thorax. 2017;72(Suppl 1):ii1–ii90. doi:10.1136/thoraxjnl-2016-209729