What is a chest tube and why is it placed?

After chest surgery, or when a lung has collapsed or fluid has built up around it, a doctor may say ‘we will put in a chest tube’. For many patients and their families this sounds frightening. This article explains what the tube is and what it does.

What is a chest tube?

MedlinePlus describes it as a hollow, flexible tube placed in the chest. The tip sits in the space between the lung and the chest wall (the pleural space) and carries out blood, fluid or air. The outer end is connected to a collection container. Suction is often used, and sometimes gravity is enough, so the lung can expand again. It is also called a chest drain.

When is it needed?

MedlinePlus says a chest tube is used for conditions that collapse or press on the lung:

• Chest surgery or injury. In major lung or heart surgery the tube is placed during the operation, under anaesthesia.
• Pneumothorax (air leaking from the lung). MedlinePlus writes that a small pneumothorax may heal on its own, but for a large pneumothorax a tube is placed between the ribs and may stay for several days.
• Pleural fluid. MedlinePlus calls a tube common for fluid caused by cancer or infection.
• Empyema (pus in the pleural space). Treatment is draining the pus with a tube, plus antibiotics.
• A tear in the oesophagus.

How is the tube placed?

According to MedlinePlus, the patient lies on one side or half-sitting with one arm raised above the head. An intravenous sedative may be given. The skin is cleaned and numbed. A small cut is made between the ribs and the tube is passed through it. A stitch and tape hold the tube in place, and a chest X-ray then checks its position. Sometimes the tube is placed with the help of X-ray, CT or ultrasound.

What are the risks?

MedlinePlus names these risks: bleeding or infection where the tube goes in, a tube in the wrong place (in tissue, the abdomen or too deep in the chest), and injury to the lung, heart or nearby organs such as the spleen, liver, stomach and diaphragm. The care team watches for these, which is why an X-ray is taken after the tube is placed.

How long does it stay?

MedlinePlus gives no set number. The tube usually stays until an X-ray shows that the blood, fluid or air has drained and the lung has expanded again. The same source says removing the tube when it is no longer needed is easy. Most patients stay in hospital until the tube is removed, but some go home with it. About a collapsed lung, MedlinePlus says a small tube or a one-way valve sometimes allows discharge, and the patient comes back to have the tube removed.

Does it hurt?

Before placement the skin is numbed. Afterwards, in its discharge instructions for lung surgery, MedlinePlus says the skin around the tube may be a little tender. The same page says there is pain when moving the arm, twisting the upper body or breathing deeply after lung surgery, and that it is better to take pain medicine as soon as pain starts rather than wait. If the pain is severe or the painkiller does not work, tell the nurse or surgeon.

What to do while you have a tube

MedlinePlus suggests:

• Practise deep breathing and repeated coughing as the nurse teaches you; it helps the lung open and drain.
• Do not kink the tube. The drainage container should always stand upright and lower than the lungs.
• The doctor will tell you when you can walk or sit in a chair.
• At home, if the tube stays: clean around it once a day.

When to report at once

MedlinePlus says that if the tube comes out or moves, cracks or comes apart at its connection, or breathing becomes harder and pain increases, you should get help at once. At home, if the tube has come out, cover the site with a clean dressing and call the surgeon at once. If you cannot reach them right then, do not wait for a reply; go to the emergency department. If breathing has become harder, call 115, Iran’s emergency number. The full list of warning signs

After the tube is removed, MedlinePlus advises keeping the dressing over the site for 1 to 2 days.

Questions you can ask the care team

• Why is the tube needed, and how many days do you expect it to stay?
• When can I start walking?
• If I go home with the tube, who checks it and removes it? (Care at home)
• Which signs mean I should report sooner?

There is also a separate page on diseases of the pleura and chest wall.