Your lungs are each surrounded by two layers of membrane (pleura). The space between the layers is called the pleural space. Normally the pleural space has a tiny amount of fluid in it. But extra fluid, blood, pus, or air in the pleural space makes it hard for the lung to expand and makes breathing difficult. A chest tube is a soft, flexible tube put into the pleural space that surrounds the lung. The tube does not go into the lung itself. The tube drains blood, air, or extra fluid. The tube is inserted through a small cut (incision) in the skin.
Reasons for a chest tube
You may need a chest tube:
After chest surgery or injury to the chest
To treat a lung infection or abscess
To remove extra fluid from around the lung from other causes. This might be from cancer or congestive heart failure.
To treat collapsed lung
To treat bleeding into the chest (hemothorax)
Chest tube placement
A chest tube is often placed during chest surgery while you’re in the operating room and still asleep (sedated). If you have a lung infection or other problem, you may have a chest tube placed while you’re awake in the emergency department or your hospital room. The procedure takes less than 30 minutes. Here’s how it is done:
Medical staff takes your blood pressure, pulse, and temperature.
You lie on your side or sit in a semi-upright position. You will be asked to put one arm up over your head.
The healthcare provider injects pain medicine (anesthetic) to numb the area where the chest tube is placed. You may be given medicine to make you relax (sedation). Sedation is given by a mask or an IV (intravenous) line in your hand or arm.
The provider makes a small incision is made in your side, chest, or back. He or she puts a soft, flexible tube into the incision site. The tube is guided between your ribs until it reaches the pleural space. The provider may use ultrasound imaging to help place the tube correctly.
The provider may sew (suture) the tube to your skin to keep it in place. It will also be covered with an airtight bandage. The tubing will be taped to your body. This is to keep it from being pulled out by accident.
The tube is then connected to a drainage device.
A chest drainage unit pulls the extra fluid, blood, pus, or air from your chest. The device should be lower than your chest level and may be put on the floor. Some chest tubes contain water and may make a bubbling sound while they are working. Other chest tubes will not make any sound at all.
A Heimlich valve (or flutter valve) is a small one-way valve. It is used if you have a collapsed lung (pneumothorax). The lung collapsed because of the collection of air in the pleural space. The valve is attached directly to the end of your chest tube. The valve opens to let air escape from the chest tube. It then closes to prevent air from going back in the tube. You may go home from the hospital with your chest tube attached to a Heimlich valve. Care for it as you are told to.
You will have an X-ray after the procedure to help confirm that the tube is in the right place.
While the tube is in place
The tube stays in place for as long as your healthcare provider thinks it is needed. You may be in the hospital until after the tube is removed. Sometimes you may be sent home with the chest tube still in place. If you are sent home with the chest tube in place, you will need home healthcare or a caregiver until it is removed.
You will be given pain medicine by mouth or by IV. You may have a patient-controlled analgesia (PCA) pump attached to the IV line. This lets you give yourself pain medicine, but it is programmed so you cannot overdose. You are usually sent home when you can take oral pain medicine and no longer need IV pain medicine.
You may need extra oxygen. This is given through a mouth mask or a flexible tube under your nose. You may also be connected to a small device called a pulse oximeter. It measures the amount of oxygen in your blood. It is placed on your finger, toe, or ear.
After the tube is placed, you can help with drainage by:
Moving and walking around if told to do so by your healthcare provider
You can reduce discomfort by holding a pillow tightly to your chest when you cough.
Your breathing and heart rate will be monitored. The tubing will be checked regularly. If blood is draining from your chest, the tubing will be checked for clots. If a clot appears, the tubing may be squeezed to move the clot out of the tube. If fluid is draining from your chest, it may be tested for signs of infection or other problems. You may need antibiotics to prevent or treat infection.
Tell a nurse right away if you have trouble breathing or chest, shoulder, or neck pain.
Risks and possible complications of chest tubes
A chest tube can have some risks. But the benefits of having the tube usually outweigh the risks. Risks of a chest tube include:
Reaction to anesthesia used during placement
Do not pull on the tube or tip over the drainage container. This can cause serious breathing problems. If you pull on the tube or tip over the container, tell a nurse right away. You may be asked to exhale fully or take deep breaths while the tubing is checked.
Removing the chest tube
When the air, blood, pus, or extra fluid is gone from the pleural space, your healthcare provider will remove the tube. This may be done in your hospital bed. You may get more pain medicine before the tube is removed. As the tube is removed, you may be asked to inhale or exhale deeply and then hold your breath. After the tube is removed, the healthcare provider may close the incision with sutures. Or the incision may be left to close by itself. The provider will put a bandage over the incision. You may have an X-ray after the tube is removed. This is to make sure your lung is still inflated.
After the tube is removed:
Follow up with the doctor within 48 hours. You may have another X-ray. This is to check for fluid or air in your lung. The incision will be checked to make sure it is healing. The bandage may be replaced with a smaller adhesive bandage. You may change the adhesive bandage as often as needed.
Care for the insertion site(s) as directed. Keep the bandage in place for 48 hours. Keep it dry.
Until a scab has formed on the incision site, you may shower but not take a bath. When a scab has formed you no longer need an adhesive bandage. After the incision has healed you may have a small scar.
When to call the doctor
While the tube is in place and after it has been removed, call the doctor (or alert your nurse) right away if you have any of the following:
Fever of 100.4ºF (38ºF) or higher, or as directed by your healthcare provider
Sharp chest pain that may spread to your shoulder or back
Bluish color of the skin
Weakness, dizziness, or fainting
A feeling of anxiety or restlessness
March 21, 2017
Placement and Management of Thoracostomy Tubes. UpToDate.
Fetterman, Anne, RN, BSN,Mancini, Mary, MD