February 2026
In this VETgirl online veterinary continuing education blog, Christine R. Smith, RVT reviews how diligent nursing care and vigilant monitoring can prevent common, often life-threatening chest tube complications in veterinary patients. Discover best practices for tube management, daily checks, and system handling to ensure patient safety and optimal outcomes.

Maintaining and Caring for Chest Tubes

By Christine R. Smith RVT, BluePearl, Senior Patient Care Training Coordinator, California Market

Dog with chest tube/radiograph combined (Image courtesy of Christine R. Smith)

Chest tubes can save lives, but if you’ve ever cared for a patient with one, you probably know that they can be a source of stress. Complications are common and sometimes life-threatening. In fact, some studies suggest that one in every three patients with a chest tube experiences associated complications. These complications are often related to tube function, securement, and system management.1 The good news is that most of these complications can be prevented with diligent nursing care and handling by the veterinary team.

Why Chest Tubes Are Placed — And Why Size Matters

Trocar chest tube (Image courtesy of Christine R. Smith)

Seldinger chest tube (Image courtesy of Christine R. Smith)

Chest tubes are typically placed when pleural fluid or air cannot be managed with intermittent thoracocentesis alone.2 They may also be placed following thoracic surgery to manage residual air or bleeding, or emergently when rapid accumulation of fluid or air results in significant respiratory compromise or hemodynamic instability.3 Understanding why the chest tube was placed helps anticipate how it will function and what challenges may arise during care.

Tube type and diameter influence both effectiveness and patient tolerance. Large-bore thoracostomy tubes are commonly used for rapidly accumulating air or blood, such as in traumatic pneumothorax or hemothorax. This may be helpful when managing viscous or fibrous effusions like pyothorax. These tubes are highly effective but can be associated with increased discomfort and higher drainage volumes that require close monitoring. Small-bore wire-guided thoracostomy tubes are frequently used for pneumothorax and postoperative management and are often better tolerated. Though these tubes may be more prone to kinking, obstruction, or migration.2

Fluid characteristics also affect tube performance. Thick or particulate effusions increase the risk of clogging, making it important to track expected drainage and recognize changes early.

Daily Care and Monitoring

Cat with chest tube covering (Image courtesy of Christine R. Smith)

Once a chest tube is in place, ongoing care and monitoring are critical to patient safety. Thoracostomy tube management requires continuous oversight, as tube disconnection, obstruction, or migration can rapidly result in life-threatening complications such as an open pneumothorax or ineffective pleural drainage.3

Ongoing monitoring helps catch small problems before they become big ones, and many complications are related to how the tube and system are managed day to day, rather than the tube itself.

Start with the Patient

Check your patient often, at least hourly initially. Frequency can then be adjusted depending on the production of air and fluid. At a minimum, checks should be performed every 2-4 hours.

  • Watch respiratory rate, effort, posture, and comfort.
  • New tachypnea, restlessness, or increased effort can be early signs of tube dysfunction or pleural reaccumulation.

Check the Tube and System

Check the tube and system every 2-4 hours. Wash your hands before handling the chest tube and wear clean exam gloves.

  • Make sure tubing is patent, unkinked, and free of loops.
  • Confirm all connections are secure and the system remains closed when not actively draining.
  • If there is a three-way stopcock, make sure the stop-cock is positioned in the “off to the patient” position.
  • Most chest tubes have a secondary clamp just below the hub of the tube. Ensure that this remains shut when the tube is not in use.
  • Disconnections can lead to an open pneumothorax.

Measure What Comes Out

Chest tube with 3-way stopcock in a cat (Image courtesy of Christine R. Smith)

Gentle aspiration with a one-way/stasis valve in a cat. (Image courtesy of Christine R. Smith)

After inspecting your chest tube, fluid and air can be aspirated from the tube. It’s important to quantify and record the amount to monitor trends. Suctioning frequency should be based on patient assessment and drainage trends rather than a fixed schedule.3 Worsening respiratory effort or increasing pleural accumulation warrants more frequent evacuation.

Intermittent or manual drainage of the chest tube can be performed using a 3-way stopcock or a one-way/stasis valve and a syringe. Strict attention to aseptic technique must be followed when handling the chest tube; adapters must be kept as clean as possible.

  • The force of aspiration should be mild to prevent damage to the thoracic tissue. Aspiration is completed once negative pressure is achieved. In some cases, the patient can be rotated to capture additional trapped pockets of fluid and air in the chest.
  • Clinical signs should always match what the chest tube is doing. A patient who remains tachypneic or hypoxemic despite negative pressure on suction may be telling you that something else is going on. In these cases, thoracic radiographs or assessment of tube patency, including sterile flushing when appropriate, can help guide next steps.
  • If using a three-way stopcock, make sure that the stopcock is turned off toward the patient. Swab the port with alcohol and then attach a new syringe to the port. Turn the stopcock so that it is open to the syringe and patient, and off to the open port. Aspirate the chest tube.
  • To empty your syringe, turn the stopcock off to the patient. Then evacuate through the open port into a container. It is preferable to leave the syringe attached to the stopcock and to empty the syringe through the open port with the extension set attached.
  • Record volume and character of air or fluid with each evacuation. Trends matter more than single numbers
  • Once you are finished manually suctioning the chest tube, make sure all clamps and ports are closed and secure. The three-way stopcock should be off to the patient, and the secondary clamp must be depressed. If needed, place caps or male adaptors on the stopcock ports to maintain a closed system.

Inspect the Insertion Site

At least once a day, remove any bandage material and inspect the tube’s insertion site. Use aseptic technique when handling the tube insertion site.

  • Damp or soiled bandages should be changed promptly using aseptic technique.
  • Tube migration or infection often shows up at the insertion site first. Inspect the surrounding skin for abnormal swelling or air and fluid pocket formation, as tube migration can allow the first fenestration to slip outside the pleural space and into the subcutaneous tissue.
  • If necessary, the insertion site can be gently cleaned using aseptic technique, particularly if discharge or debris is present. Care should be taken to avoid excessive manipulation of the tube or surrounding tissues.
  • Once the inspection is completed, sterile dressing such as PrimaporeTM or TegadermTM should be placed over the insertion site.
  • A chest wrap, stockinet, or T-shirt can be placed over the patient’s thorax to hold the chest tube in place and prevent snagging.

A Fresh Opinion on the Three-Way Stopcock

Three-way stopcocks can be useful for controlled evacuation of pleural air or fluid, especially when removing large volumes. But in my experience, they are also a frequent source of unintended problems. Because they rely on correct positioning every time they are accessed, even small handling errors can lead to loss of negative pressure, air entry into the pleural space, or ineffective drainage.5 As equipment options have evolved, one-way adaptors and stasis valves offer a safer, more intuitive alternative by automatically controlling airflow direction and reducing the risk of user error during routine chest tube management.4

What Human Medicine Can Teach Us

In human hospitals, standardized chest tube protocols and checklists are designed to reduce preventable complications, yet complication rates remain significant.5 Veterinary medicine lacks many of these formal safeguards, which means outcomes rely heavily on frequent physical assessment and individual vigilance. Interestingly, despite these differences, the types of complications reported across species remain strikingly similar.

Chest tubes will always carry inherent risk, but thoughtful handling and consistent reassessment can dramatically reduce preventable complications. When the system is respected and checked routinely, chest tubes become a powerful tool rather than a source of stress.

References:

  1. Boullhesen Williams T, Fletcher D, Fusco J, et al. Retrospective evaluation of the use and complications of small-bore wire-guided thoracostomy tubes in dogs and cats: 156 cases (2007–2019). Front Vet Sci 2022;9:818055.
  2. Rudloff E. Thoracostomy tube placement. In: World Small Animal Veterinary Association Congress Proceedings 2017. World Small Animal Veterinary Association.
  3. Burkitt JM, Creedon JM. Pleural space. Advanced monitoring and procedures for small animal emergency and critical care. In: J. M. Burkitt & J. M. Creedon (Eds.). Wiley-Blackwell; 2012:385-392.
  4. MILA International, Inc. Small-bore wire-guided thoracostomy tube: Instructions for use. https://www.milainternational.com. 2024.
  5. Kwiatt M, Tarbox A, Seamon MJ, et al. Thoracostomy tubes: A comprehensive review of complications and related topics. Int J of Crit Illn Inj Sci,2014; 4(2):143–155. https://doi.org/10.4103/2229-5151.134182

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