Pulmonology - Chest Tube Placement

In this episode, we review chest tube placement (tube thoracostomy), a potentially lifesaving procedure used to remove air, blood, pus, or other fluid from the pleural space. We discuss the major indications, including pneumothorax, hemothorax, empyema, chylothorax, and symptomatic pleural effusions, along with important contraindications and anatomical landmarks, particularly the triangle of safety. The segment also covers the procedural approach, emphasizing sterile technique, appropriate tube selection, insertion superior to the rib to avoid the intercostal neurovascular bundle, and connection to a pleural drainage system. We finish with high-yield clinical pearls highlighting the importance of monitoring air leaks and drainage output, recognizing complications such as malposition, bleeding, infection, and recurrent pneumothorax, and understanding the criteria for safe chest tube removal.

References

1. Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817
2. Anderson,Devon, Chen SA, Godoy LA, Brown LM, Cooke DT. Comprehensive Review of Chest Tube Management: A Review. JAMA Surgery. 2022;157(3):269-274
3. Light, Richard, David Feller-Kopman. Pleural Disease. N Engl J Med. 2018;378(8):740-751
4. Ling, Brit, Aaron J Lacy, Jessica Mason, Michael Gottlieb. Tube Thoracostomy and Pleural Catheters: A Review for Emergency Clinicians. J Emerg Med. 2025;77:100-116