Chest tube

Pronunciation
Other names
Medical specialty
Uses
Complications
Approach
Types
Recovery time
Other options
Frequency

File:Dreno torácico tubular multiperfurado.JPG

Size of chest tube

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Portable electronic system

File:Labelled chest tube drainage system.png

Chest tube drainage system diagram, with parts labeled in

A chest tube (also known as a chest drain, thoracic catheter, tube thoracostomy, or intercostal drain) is a flexible plastic tube inserted through the chest wall into the pleural space or mediastinum. Its primary function is to remove air, fluid, or pus from the thoracic cavity. Common indications include pneumothorax, pleural effusion, hemothorax, chylothorax, and empyema.

Chest tubes play a crucial role in managing patients with thoracic trauma, postoperative thoracic procedures, and conditions leading to pleural fluid accumulation.

The practice of chest drainage dates back to Hippocrates, who used incision, cautery, and metal tubes for treating empyema. However, widespread use did not occur until the 1917 influenza epidemic, with further advancements in World War II and the Korean War.

Indications

File:Pneumothorax CT.jpg

Left-sided pneumothorax (right side of image) on CT scan of the chest with chest tube in place.

A chest tube is indicated in the following conditions:

• Pneumothorax – Accumulation of air or gas in the pleural space.
• Pleural effusion – Excess fluid accumulation in the pleural cavity.

Chylothorax – Accumulation of lymphatic fluid. Empyema – Collection of pus due to infection. Hemothorax – Presence of blood in the pleural space. Hydrothorax – Presence of serous fluid in the pleural space.

Contraindications

Chest tube placement is generally safe, but some conditions may contraindicate its use:

• Severe coagulopathy – Increased bleeding risk.
• Diaphragmatic hernia – Risk of injury to abdominal organs.
• Pleural adhesions – Risk of trauma to surrounding structures.
• Hepatic hydrothorax – Risk of fluid imbalance and recurrence.

Common Complications

• Chest tube clogging – The most frequent complication, leading to fluid accumulation.
• Infection – Introduction of bacteria into the pleural space.
• Persistent air leaks – May require prolonged drainage.
• Pain and discomfort – Common during insertion and while in place.

Serious Complications

• Hemorrhage – Injury to blood vessels during insertion.
• Lung injury – Including reexpansion pulmonary edema.
• Diaphragm, liver, or spleen injury – If placed incorrectly.
• Thoracic aorta or heart injury – Rare but life-threatening.
• Subcutaneous emphysema – Air accumulation under the skin due to a blocked drain.

Traditional Chest Tubes

File:Dreno torácico tubular multiperfurado.JPG

Size of chest tubes:

Sizing Guidelines:

• Adult males: 28–32 Fr
• Adult females: 28 Fr
• Children: 18 Fr
• Newborns: 12–14 Fr

Traditional chest tubes are clear plastic with multiple drainage holes, distance markers, and a radiopaque stripe for visibility on X-ray.

Channel-Style Drains (Blake Drains)

Channel-style drains (e.g., Blake drains) use capillary action rather than active suction to remove fluids, and they may cause less pain compared to rigid tubes.

Chest Drainage Systems

File:Labelled chest tube drainage system.png

Chest tube drainage system diagram, showing labeled parts.

A chest drainage system is used to collect air, blood, or fluid. It consists of:

1. Collection Chamber – Gathers drained fluids. 2. Water Seal Chamber – Prevents air from re-entering the pleural space. 3. Suction Control Chamber – Regulates negative pressure.

Modern systems may use mechanical check valves or electronic suction for continuous monitoring.

Procedure

== Tube Thoracostomy (Insertion Technique) Chest tube insertion follows these key steps:

1. Patient Preparation:

• Position: Semi-recumbent or supine.
• Local anesthesia to minimize pain.
• Sterile drapes and antiseptic preparation.

2. Insertion Site:

• Safe Zone: Between the anterior axillary line and midaxillary line, at the 5th intercostal space.
• Inferior insertions risk injury to the liver, spleen, or diaphragm.

3. Placement:

• A small incision is made, and a blunt dissection technique is used.
• The tube is inserted and secured with sutures.
• A chest X-ray confirms placement.

4. Connection to Drainage System:

• The tube is attached to a water seal or suction device.
• Continuous monitoring for air leaks or fluid output.

Postoperative Chest Tube Use

Post-surgical placement differs, typically involving:

• Multiple drains for different compartments.
• Lower suction settings to prevent lung collapse.
• Early mobilization to promote drainage.

Chest Tube Removal

• The tube is removed once drainage decreases and there is no evidence of air leaks.
• The suture site is dressed and monitored for any fluid accumulation.

Dressing and Fixation

• Dressings should be sterile and secured to prevent infection.
• A bridle rein (tape bridge) is recommended to minimize tension on sutures.

Monitoring and Maintenance

• Keep tubes free of kinks and dependent loops to ensure proper drainage.
• Avoid unnecessary clamping, which can cause tension pneumothorax.
• Manual manipulation (milking/stripping) is controversial and may increase negative pressure.

Innovations in Chest Drainage

• Digital chest drainage systems provide real-time monitoring of pressure and air leaks.
• Portable ambulatory devices allow for home drainage in select cases.

See Also

• Thoracic surgery
• Pneumothorax
• Pleural effusion
• Hemothorax
• Thoracotomy
• Chest trauma

External Links

• American Thoracic Society
• New England Journal of Medicine – Chest Tube Insertion

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