Chest tube

A chest tube (also chest drain, thoracic catheter, tube thoracostomy or intercostal drain) is a surgical drain that is inserted through the chest wall and into the pleural space or the Mediastinum. The insertion of the tube is sometimes a lifesaving procedure. The tube can be used to remove clinically undesired substances such as air (pneumothorax), excess fluid (pleural effusion or hydrothorax), blood (hemothorax), chyle (chylothorax) or pus (empyema) from the intrathoracic space. An intrapleural chest tube is also known as a Bülau drain or an intercostal catheter (ICC), and can either be a thin, flexible silicone tube (known as a "pigtail" drain), or a larger, semi-rigid, fenestrated plastic tube, which often involves a flutter valve or underwater seal.

The concept of chest drainage was first advocated by Hippocrates when he described the treatment of empyema by means of incision, cautery and insertion of metal tubes. However, the technique was not widely used until the influenza epidemic of 1918 to evacuate post-pneumonic empyema, which was first documented by Dr. C. Pope, on a 22-month-old infant. The use of chest tubes in postoperative thoracic care was reported in 1922, and they were regularly used post-thoracotomy in World War II, though they were not routinely used for emergency tube thoracostomy following acute trauma until the Korean War.

Medical uses of chest tube include in emergency situations (for example in the case of a collapsed lung, or pneumothorax) and also after surgery to drain fluid and air from the chest, allow the lung to re-expand and prevent post-surgical complications. List of specific medical uses:

Contraindications to chest tube placement include refractory coagulopathy and presence of a diaphragmatic hernia, as well as hepatic hydrothorax. Additional contraindications include scarring in the pleural space (adhesions).

Complications that are sometimes associated with chest tubes include the potential for clogging, air leaks, infection, hemorrhage, re-expansion pulmonary edema. Injury to the liver, spleen or diaphragm is also possible if the tube is placed behind (inferior) to the pleural cavity or is mispositioned. Injuries to the thoracic aorta and heart can also occur. The rate of complications of chest tubes inserted for trauma-related treatment needs has been estimated at 19%. The rate of complications is variable and other estimations have been made that share a rate of closer to 40%.

Complications that arise while the chest tube is being inserted or within the first day of the insertional procedure include a risk of injury to organs near the insertional site.

Complications that arise after the tube has been inserted for one day or longer include the potential for tube blockages (obstruction), air leaks, kinking, or entrapment in the lung fissure once the lung has been expanded. Chest tube clogging can lead to retained blood around the heart and lungs that can contribute to complications and increase mortality. A common complication after thoracic surgery that arises within 30–50% of patients are air leaks. If a chest tube clogs when there is an air leak the patient will develop a pneumothorax. This can be life-threatening. Here, digital chest drainage systems can provide real time information as they monitor intra-pleural pressure and air leak flow, constantly. Keeping vigilant about chest tube clogging is imperative for the team taking care of the patient in the early postoperative period.

Minor complications include a subcutaneous hematoma or seroma, anxiety, shortness of breath, and cough (after removing large volume of fluid). In most cases, the chest tube related pain goes away after the chest tube is removed, however, chronic pain related to chest tube induced scarring of the intercostal space is not uncommon.^{[citation needed]}