Thoracostomy (Chest Tube Insertion)

A chest tube can help drain air, blood, or fluid from the space surrounding your lungs, called the pleural space.

Chest tube insertion is also referred to as chest tube thoracostomy. It’s typically an emergency procedure. It may also be done after surgery on organs or tissues in your chest cavity. During chest tube insertion, a hollow plastic tube is inserted between your ribs into the pleural space. The tube may be connected to an underwater seal to help with the drainage. The tube will stay in place until the fluid, blood, or air is drained from your chest.


You may need a chest tube if you have any of the following:

  • a collapsed lung
  • a lung infection
  • bleeding around your lung, especially after a trauma
  • fluid build-up due to another medical condition, such as cancer or pneumonia
  • breathing difficulty due to a build-up of fluid or air
  • surgery, especially lung, heart, or esophageal surgery

Inserting a chest tube may also help your doctor diagnose other conditions, such as lung damage or internal injuries after a trauma.

Chest tube insertion is most commonly performed emergency procedure, so there’s usually no way for you to prepare for it. Your doctor will ask for your consent to perform the procedure if you’re conscious.

If you’re unconscious, they’ll explain why a chest tube was necessary after you wake up. In cases where it isn’t an emergency, your doctor will order a chest X-ray before chest tube insertion. This is done to help confirm whether fluid or air buildup is causing the problem and to determine if a chest tube is needed. Some other tests may also be done to evaluate pleural fluid, such as a chest ultrasound or chest CT scan.

Your doctor will prepare a large area on the side of your chest, from your armpit down to your abdomen and across to your nipple. Preparation involves sterilizing the area and shaving any hair from the insertion site, if necessary. Your doctor may use an ultrasound to identify a good location for inserting the tube.

  • Anesthesia: The doctor may inject an anesthetic into your skin or vein to numb the area. The medication will help make you more comfortable during the chest tube insertion, which can be painful.
  • Incision: Using a scalpel, your doctor will make a small incision between your ribs, near the upper part of your chest. Where they make the incision depends on the reason for the chest tube.
  • Insertion: Your doctor will then gently open a space into your chest cavity and guide the tube into your chest. Chest tubes come in various sizes for different conditions. Your doctor will stitch the chest tube in place to prevent it from moving. A sterile bandage will be applied over the insertion site.
  • Drainage: The tube is then attached to a special one-way drainage system that allows air or fluid to flow out only. This prevents the fluid or air from flowing back into the chest cavity. While the chest tube is in, you’ll probably need to stay in the hospital. A doctor or nurse will monitor your breathing and check for possible air leaks.

How long the chest tube is left in depends on the condition that caused the buildup of air or fluid. Some lung cancers can cause fluid to re-accumulate. Doctors may leave the tubes in for a longer period of time in these cases.

Chest tube insertion puts you at risk of several complications. These include

  • Pain during placement
  • Infection
  • Poor tube placement
  • Bleeding into the pleural space
  • Injury to the lung, diaphragm, or stomach
  • Collapsed lung during tube removal

Consult with our experienced Anesthesiologists

JNU is home to some of the most eminent doctors in the world, most of whom are pioneers in their respective arenas and are renowned for developing innovative and revolutionary procedures