Placement and management of thoracostomy tubes
- Peter Doelken, MD, FCCP
Peter Doelken, MD, FCCP
- Associate Professor
- Albany Medical College
- Section Editors
- Polly E Parsons, MD
Polly E Parsons, MD
- Editor-in-Chief — Pulmonary, Critical Care, and Sleep Medicine
- Section Editor — Critical Care
- Professor of Medicine
- University of Vermont College of Medicine
- Allan B Wolfson, MD
Allan B Wolfson, MD
- Section Editor — Adult Procedures
- Professor of Emergency Medicine
- University of Pittsburgh
- Joseph S Friedberg, MD
Joseph S Friedberg, MD
- Section Editor — Thoracic Surgery
- Professor of Surgery
- University of Pennsylvania
- Anne M Stack, MD
Anne M Stack, MD
- Section Editor — Pediatric Procedures
- Associate Professor, Department of Pediatrics
- Harvard Medical School
- Heidi L Frankel, MD, FACS
Heidi L Frankel, MD, FACS
- Section Editor — Trauma surgery
- Professor of Surgery
- University of Southern California
Tube thoracostomy is a procedure in which a tube is placed through the chest wall into the pleural cavity primarily to drain an air or fluid collection from the pleural space, but the tube can also be used to instill medications for pleurodesis.
The indications, contraindications, technique, management, and complications of thoracostomy tube placement will be reviewed here. Specific medical and surgical conditions that result in the need to perform thoracostomy for pleural drainage are discussed in separate topic reviews.
Thoracostomy tube placement is indicated for the following conditions:
•Spontaneous pneumothorax (see "Primary spontaneous pneumothorax in adults")
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- Antibiotic prophylaxis
- Tube selection
- - General considerations
- - Pneumothorax
- - Tension pneumothorax
- - Hemothorax
- - Malignant effusion
- - Parapneumonic effusion
- - Empyema
- Insertion site
- Drainage system
- - Level of suction
- Role of ultrasound or other imaging
- Tube thoracostomy
- - Standard technique
- - Seldinger technique
- Needle thoracostomy
- MANAGEMENT OF THORACOSTOMY TUBES
- Assessing air leak
- Managing initial drainage
- Troubleshooting thoracostomy tubes
- Management during thoracic procedures
- Outpatient management
- - Criteria: Pneumothorax
- - Criteria: Effusion
- - Removal technique
- Chest tube malposition
- Organ injury
- Re-expansion pulmonary edema
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS