Chest Tube Management

How to give intrapleural tPA & Dornase:

There is evidence to support the administration of tPA+DNAse simultaneously. However, you should give it separately if the pulmonary team states otherwise.

Step-by-step instructions

  1. tPA will arrive at bedside (it is only usable ~30 mins after it arrives at bedside)
  2. Turn off suction on chest tube
  3. Turn the stopcock towards the PleurEvac (C) (the direction that the stopcock is pointing to = direction that it’s blocking).
  4. Administer the tPA (and Dornase), observing usual sterile technique (dosage may vary based on pulmonary team recommendations)
  5. Flush chest tube with 30cc sterile saline flush
  6. Turn the stopcock towards the patient (A) to trap the tPA and dornase in the patient’s pleura
  7. Wait 1 hour to allow the medication to work
    • If you are asked to administer tPA & Dornase separately, you can repeat Steps 3-7 with Dornase.
  8. Turn the stop cock to the tPA port (B) & allow drainage from the lungs to the PleurEvac
  9. Restart chest tube to suction -20

Chest Tube

Anticipatory planning:

  • STOP administering if patient has pleural hemorrhage (frank blood)
  • Having some blood-tinged pleural fluid is common, if it continues to become more bloody, ask pulmonary consult team to assess
  • When in doubt, OK to hold a treatment and talk to pulmonary consult team


Thanks to Dr. Duong for allowing me to build off his chest tube instructions

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