Why Do I Need a Chest Tube?

Chest tube thoracostomy, commonly referred to as “putting in a chest tube”, is the insertion of a hollow plastic tube into the pleural cavity (space around the lungs) to drain air, blood, pus or other fluids. Whether the excess air or fluid is the result of a traumatic injury, cancer, pneumonia or another condition, insertion of a chest tube allows for “continuous, large volume drainage” until the underlying condition that’s causing the build-up can be properly addressed.^[1]

Common Reasons Why a Chest Tube is Needed

There are a number of reasons why a chest tube may be needed. They include:^[2]

• Pneumothorax – occurs when the lung is accidentally punctured and air accumulates in the pleural space causing it to collapse. Failure to remove the air can be life-threatening. Once the air is removed, the lung re-expands and the leak is sealed.
• Hemothorax – occurs when blood accumulates in the pleural space usually because of a severe, traumatic chest injury. Prompt identification and treatment – typically with a chest tube – is a vital part of caring for a patient with a traumatic injury.¹
• Pleural Effusion – occurs when extra fluid builds up inside the pleural space usually because of a condition such as cancer or pneumonia.
• Infection – if there’s an infection in the excess fluid surrounding the lung, a chest tube may be needed to remove it. Oftentimes, this helps the infection heal faster.
• Cancer – when cancer spreads to the lungs or pleura (lining of the lungs), large amounts of fluid can accumulate in the pleural space. Sometimes, doctors will remove this fluid with a needle. If the fluid continues to accumulate, however, a chest tube may be needed to first, drain the fluid, and then deliver special medications through the tube to reduce the chances of the build-up re-occurring.
• Comfort – when excessive amounts of air or fluid accumulate in the pleural space, patients can experience discomfort and shortness of breath. Inserting a chest tube to remove some of that air or fluid reduces discomfort making it easier for patients to breathe.
• Chest Surgery – sometimes a chest tube is left in place after chest surgery. It usually remains until there is no more drainage coming from the surgical site. Your doctor can tell you how long they are usually left in, considering the type of surgery you had and your post-operative condition.

Preparing for Insertion of a Chest Tube

Usually, the accumulation of air or fluid around the lungs is identified with a chest X-ray, although a chest ultrasound or CT scan may also be used. If the X-ray shows the need for air or fluid to be drained, a surgeon, pulmonologist, critical care doctor or interventional radiologist will be called upon to perform the procedure. Adults and older children usually remain awake during the procedure. Young children may be given a sedative to keep them calm.²

The skin will be cleansed and a local anesthetic will be injected to numb the area between the ribs where the chest tube will be inserted. A small incision will be made and the chest tube will be inserted through that incision.  The doctor will guide the tube into the chest and then stitch it into place to prevent it from slipping out. A sterile dressing will be placed over the insertion site and changed according to the doctor’s instruction. ²

What Happens Once the Chest Tube is in Place?

Most patients stay in the hospital the entire time the chest tube is in place. After it’s inserted, it will be attached to a suction machine unit that will gently extract the mucus or other bodily fluids from the chest cavity. Hospital staff will check the chest tube frequently to make sure there are no air leaks or plugging of the tube. They will also assess your breathing, which should improve once the chest tube is in place. If there are no complications, there will be less and less drainage every day until at which time there is minimal to no drainage at all and the chest tube will be removed.²

What about Complications?

The risk of complications from chest tube placement are minimal; less than 5 percent. Your doctor should explain possible risks and complications before you sign consent for the procedure. Below are some possible risks/complications your doctor may review with you: ²

• Pain during insertion – your doctor should give you a local anesthetic to minimize the risk of pain. However, the injection containing the anesthetic may hurt a little.
• Bleeding – there is a slight chance that a blood vessel in the skin or chest wall can be accidentally nicked during insertion of the tube. Usually, this type of bleeding stops on its own. In rare cases, there may be bleeding in or around the lung that may require surgery.
• Infection – bacteria can enter the body through the insertion site and cause an infection in the lung. The longer the chest tube stays in place, the higher the risk of infection. Special care must be taken during dressing changes to help minimize the risk of infection.

Removing the Chest Tube

Once your doctor determines the chest tube is no longer needed, it will be removed. This procedure takes only a few minutes and is usually done at the bedside. There will be a dressing over the insertion site and your doctor will give you instructions on how and when it should be changed or removed. You will most likely have a follow-up visit with your doctor, at which time you may have to have another chest X-ray. This is just to make sure the air or fluid hasn’t returned. Once the incision site heals, you will have a small scar.²

For more information about why you may need a chest tube, talk to your primary care provider or your pulmonologist.

_{[1] Shlamovitz, Gil Z., MD, FACEP, et. al. Tube Thoracostomy. Medscape. Updated September 13, 2016.}

_{[2] American Thoracic Society. Chest Tube Thoracostomy. Accessed November 25, 2017.}