Chest Tube Procedure

What Is a Chest Tube?

A chest tube is a plastic tube that is used to drain fluid or air from the chest. Air or fluid (for example blood or pus) that collects in the space between the lungs and chest wall (the pleural space) can cause the lung to collapse. Chest tubes can be inserted at the end of a surgical procedure while a patient is still asleep from anesthesia or at the bedside using a local pain killer and some sedation. Chest tubes come in a variety of shapes and sizes. Depending on what they are needed for, they can range in diameter from as small as a shoelace to as large as a highlighter.

Chest tubes are usually connected to drainage systems that collect fluid and allow air to escape from the chest. These systems can be allowed to drain passively or can have suction applied to them.

What to Expect

When chest tubes are placed in a patient who is awake, patients can expect to receive some form of local pain killer where the chest tube will be inserted. Often, patients are also given medicine to help ease anxiety. Although efforts are made to make the procedure more tolerable, patients still usually experience some discomfort. Some chest tubes are inserted after the skin and muscles of the chest wall are cut and gently spread apart. Some chest tubes are inserted after a wire is placed into the chest through a needle and the wire acts as a track for the tube to follow. In both cases, patients often report some discomfort after the procedure as the tube lies on the ribs and moves slightly with each breath. Luckily, this discomfort is usually temporary.

The main goal of this procedure is drainage of the pleural space. Patients can expect to see or feel the fluid or air leaving the chest. Often, patients may feel the collapsed lung re-expanding. A chest X-ray will be performed after the procedure to see how much air or fluid has been drained, how much the lung has re-expanded, and to determine the final position of the chest tube. Chest tubes remain in place for a variable number of days. Usually, when the amount of fluid draining from the tube is low, or there is no more air escaping through the tube, it can be removed.

Like any surgical procedure, the primary risks with chest tube placement are bleeding and infection. Practitioners are careful to avoid the blood vessels that run on the underside of the ribs during placement. In order to avoid introducing an infection, the entire procedure is performed in a sterile fashion. The other major risks involve damage to the other structures in the chest, like the lungs and heart. Though injuries to these structures are very uncommon, they can be serious.

Chest tubes are kept in place by stitches and are covered by a sterile dressing. Mild discomfort at the site of insertion is common. If you have severe pain or difficulty breathing, call for help right away. The duration for which a chest tube is needed varies but is usually a few days. In certain situations, patients can be sent home with a chest tube; however, in most cases they are removed before discharge from the hospital. Your healthcare provider will remove the chest tube by cutting the stitches that hold it in place. Mild discomfort during removal may occur.

What Are the Risks?

• Pain during insertion and after placement of chest tube: Although pain during insertion and mild discomfort after placement are common, your healthcare provider can help minimize these effects with pain medicines.
• Infection
• Improper placement
• Dislodged chest tube
• Collapsed lung after removal of chest tube
• Bleeding at the site of insertion
• Bleeding into the pleural space (space around lungs) or within the abdomen
• Injury to the lung
• Injury to other organs, such as heart, spleen, liver, diaphragm

Your healthcare provider will take measures to minimize the risk of these complications. Serious complications are uncommon.