A chest tube, or thoracostomy tube, manages conditions that disrupt normal pressure dynamics within the chest cavity. This intervention is required when air, fluid, or blood accumulates in the pleural space between the lung and the chest wall. The primary goal is to evacuate these substances, helping the collapsed or compressed lung re-expand fully. Historically, the practice of “milking” or “stripping” the tube was used to clear blockages, but this manual technique is now controversial. This article examines the chest tube’s function and the current medical consensus regarding aggressive manipulation techniques.
The Purpose of a Chest Tube
The pleural space maintains negative pressure, keeping the lungs inflated against the chest wall. Conditions like a pneumothorax (air) or a hemothorax (blood) abolish this pressure, leading to lung collapse. A chest tube is inserted to create a one-way path for trapped air or fluid to escape, preventing re-entry.
The tube connects to a drainage system with a water seal, allowing fluid and air to exit while maintaining negative pressure inside the chest. This drainage and pressure restoration enables the affected lung to re-inflate, improving the patient’s breathing and oxygenation. Monitoring the drainage system, including the amount and type of fluid removed, is essential.
What is Chest Tube Milking
Chest tube milking is a manual technique intended to clear potential obstructions, such as blood clots or thick drainage, from the tubing. The procedure involves sequentially squeezing and releasing a section of the tube along its length, moving toward the collection system. This action generates a brief, high-pressure pulse meant to mechanically push debris through the tube.
A similar, more aggressive technique is “stripping,” which involves firmly compressing the tube and sliding the pinched fingers down its entire length. Both milking and stripping are non-standardized interventions that create a significant spike in negative pressure inside the chest tube to dislodge blockages and ensure continuous drainage.
Potential Harm from Aggressive Stripping
Aggressive manipulation, particularly stripping, is not recommended because it generates dangerously high negative intrapleural pressure. Stripping can create pressure bursts up to -400 cm H2O, which is significantly greater than the typical suction pressure of -10 to -20 cm H2O applied to the system. This extreme pressure spike is the primary source of potential harm.
The sudden, intense negative pressure can cause trauma to the pleural lining and lung tissue surrounding the tube’s internal holes. This suction-induced injury risks pulling the lung tissue into the drainage holes, a phenomenon called tissue entrapment. Furthermore, the mechanical irritation can potentially re-initiate bleeding or cause a new hemorrhage at the surgical site. Current clinical guidelines advise against routine stripping or milking due to the lack of proven benefit and the risk of tissue damage.
Maintaining Patency Through Alternative Methods
The standard of care for maintaining chest tube patency focuses on methods that avoid generating high negative pressure spikes. Proper patient positioning promotes continuous drainage by gravity. Ensuring the drainage system is kept below the level of the patient’s chest prevents fluid from siphoning back into the pleural space.
Monitoring the tubing for kinks, loops, or loose connections that could impede flow is essential. If a clot is visible, healthcare providers can use a gentle, hand-over-hand squeezing technique to lightly compress the tube and move the clot without creating excessive pressure. This gentle squeezing is distinct from aggressive stripping. These accepted practices, combined with routine monitoring for fluctuations in the water seal chamber, prioritize patient safety while ensuring the tube remains functional.