Placement of a tube between the ribs to drain air or fluid that has accumulated in the chest cavity. It allows the lung to re-expand.
Indication
- Pneumothorax (air accumulation between the lung and chest wall)
- Hemothorax (blood accumulation in the chest cavity, often after trauma)
- Empyema or infected pleural fluid collection
- Large pleural effusion (fluid accumulation) with respiratory distress
- Chylothorax (lymphatic fluid accumulation)
- Drainage following cardiac or thoracic surgery
Preparation
- IV access, monitoring, and oxygen support are arranged
- Insertion site is identified using a chest X-ray and, if needed, ultrasound or CT
- The area is sterilized; local anesthesia (lidocaine) is prepared
- Coagulation tests and complete blood count are reviewed
How it's performed
- The patient is positioned supine with the arm raised above the head
- The 4th-5th intercostal space at the mid-anterior axillary line (in front of the armpit) is typically marked; this is the safe triangle preferred for pneumothorax and hemothorax
- Local anesthesia is applied to the skin and rib periosteum; a small skin incision is made
- Blunt dissection is used to enter the pleural space; after digital exploration, the chest tube is placed
- The tube is secured to the skin with a suture and connected to a sealed underwater drainage system
- After placement, a chest X-ray is taken to confirm tube position and lung re-expansion
Post-procedure
- Drainage volume, air leak, and patient breathing are recorded hourly
- Daily examination for tube blockage and leakage
- When drainage decreases and air leak resolves, the tube is clamped, a check X-ray is taken, and the tube is removed
- After tube removal, a suture is placed and the area is closed
- Early mobilization and breathing exercises are recommended
Risks
- Bleeding, lung or vessel injury
- Damage to diaphragm, liver, or spleen (improper placement)
- Pleural space infection (empyema)
- Malposition, kinking, or dislodgement of the tube
- Re-expansion pulmonary edema (when the lung re-expands rapidly)
FAQ
How long does the chest tube stay in?
Usually 1-7 days. The air leak is expected to stop and drainage to fall below a certain daily volume.
Is the procedure painful?
Sharp pain is minimal because the skin and tissue are numbed with local anesthesia. Some discomfort may occur while the tube is in place; pain relievers are provided.
How is the tube removed?
While the patient takes a deep breath and holds it, the tube is pulled out quickly and the site is closed with a suture. It usually takes only a few minutes.
Will the lung return to normal afterward?
In most patients, the lung fully re-expands. In recurrent pneumothorax, additional surgical methods may be needed.
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