Thoracostomy

Thoracostomy, commonly called tube thoracostomy, is a medical procedure in which a chest tube is inserted through the chest wall into the pleural space to drain air, blood, pus, or other pleural fluid and to re-expand a collapsed lung. It is distinct from thoracentesis, which uses a needle or small catheter for limited aspiration of pleural contents.

Indications include pneumothorax (spontaneous or traumatic), tension pneumothorax, pleural effusion, empyema, hemothorax, postoperative drainage after thoracic surgery, and chylothorax. It may be used emergently to relieve air or fluid buildup and to allow lung re-expansion or ongoing drainage.

Technique involves sterile preparation and usually local anesthesia (with or without sedation). The chest tube is placed through the intercostal space, typically in the midaxillary line around the 4th or 5th intercostal space, just above the upper border of the rib to avoid the neurovascular bundle. The tube may be placed using blunt dissection or a percutaneous (Seldinger) approach. After insertion, the tube is connected to a drainage system with a water-seal basin and, if indicated, suction. The site is secured with sutures and an airtight dressing. Placement is confirmed clinically and radiographically.

Complications can include infection, bleeding, injury to thoracic or abdominal organs, persistent air leak, subcutaneous emphysema, and chest tube malposition or dislodgement. The chest tube remains in place until lung re-expansion is achieved and drainage is minimal, after which removal is performed with care to avoid recurrence.