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Chest Tube Insertion

(Tube Thoracostomy)

By Noah Lechtzin, MD, MHS, Associate Professor of Medicine and Director, Adult Cystic Fibrosis Program, Johns Hopkins University School of Medicine

Chest tube insertion (also called tube thoracostomy) is insertion of a tube into the space between the lung and chest wall (called the pleural space). The procedure is done to drain air from the space if the lung is collapsed (a condition called pneumothorax). It is also sometimes done to drain fluid from the pleural space (called pleural effusion), particularly if the fluid accumulates continually so that it cannot be drained all at once. In some situations, insertion of a chest tube is an emergency, potentially life-saving procedure.

Chest tube insertion is done with the person awake, although sometimes a sedative is given. The doctor anesthetizes the area between two ribs and then makes a small incision and inserts the tube. The tube is connected to suction. A chest x-ray is usually done after the tube is inserted to confirm correct placement. Complications are infrequent and rarely serious. They can include chest pain, puncture of the lung or diaphragm, accumulation of air under the skin, and infection. If a large amount of fluid that has been present for weeks to months is withdrawn rapidly, fluid can accumulate within the lung itself (pulmonary edema). Occasionally, a tube needs to be replaced because it kinks, becomes dislodged, or becomes blocked by a blood clot.