From the Guidelines
A chest drain, also known as a chest tube or thoracostomy tube, is a flexible plastic tube inserted through the chest wall into the pleural space to remove air, fluid, blood, or pus from around the lungs, with its primary purpose being to restore normal lung function by evacuating abnormal collections that prevent the lung from fully expanding, as supported by recent studies such as 1 and 1. The chest drain is used to treat various conditions, including pneumothorax, hemothorax, pleural effusion, empyema, or after chest surgery. The tube connects to a drainage system that may include a water seal chamber and suction control to facilitate drainage while preventing air from re-entering the pleural space. Chest drains typically remain in place until the underlying condition resolves, which may range from a few days to weeks depending on the situation. The procedure requires sterile technique during insertion, regular monitoring for proper function, and careful management to prevent complications such as infection, tube dislodgement, or blockage, as highlighted in guidelines such as 1, 1, and 1. Chest drains work by reestablishing negative pressure in the pleural space, allowing the lung to re-expand and resume normal respiratory function. Key considerations in chest drain management include the use of ultrasound to guide insertion, the selection of the appropriate drain size and type, and the careful monitoring of drainage output and patient symptoms, as discussed in studies such as 1 and 1. The decision to remove the chest drain is guided by factors such as the absence of air leaks, the volume and appearance of the fluid drained, and the presence of pleural effusion on chest x-ray, with recent guidelines such as 1 recommending removal as soon as air leaks are no longer observed and the drain produces minimal fluid. Overall, the effective management of chest drains is critical to optimizing patient outcomes and minimizing complications, and should be guided by the latest evidence and clinical guidelines.
From the Research
Definition and Purpose of a Chest Drain
A chest drain, also known as a thoracostomy tube, is a medical device used to remove fluid, air, or blood from the pleural space, which is the space between the lungs and the chest wall 2, 3. The purpose of a chest drain is to treat various pleural diseases, such as malignant effusions, serous fluid, pus, or blood in the pleural cavity, and to relieve symptoms such as shortness of breath and chest pain.
Key Features and Types of Chest Drains
Chest drains come in different designs, including straight, angled, and pig-tail tubes, and are made of various materials, such as PVC and silicone 2. Modern chest drainage units often incorporate smart digital systems that monitor and graphically report pleural pressure and evacuated fluid/air, improving patient outcomes. There are also different types of drainage systems, including closed drainage systems and water-seal systems, which help to prevent the entry of air into the pleural space and reduce infection risk 4.
Indications and Management of Chest Drains
Chest drains are used in a variety of clinical indications, including lung surgery, and can be lifesaving in certain circumstances 3. The management of chest drains requires careful observation, patient characteristics, and operative procedures that have been performed 4. The removal of chest tubes is a common procedure, and the technique of removal is not as important as how it is done and the preparation for the procedure.
Potential Complications of Chest Drains
Potential complications of chest drains include intrapulmonary placement, which can lead to immediate improvement in pleural abnormalities, but also to dramatic increase or development of chest wall emphysema or pneumothorax, prolonged air leaks, recurrent pneumothorax, pneumonia, retained hemothorax or empyema, and subsequent thoracic surgery 5. Therefore, careful placement and management of chest drains are crucial to prevent these complications and ensure optimal patient outcomes.
- Common complications of chest drains:
- Intrapulmonary placement
- Prolonged air leaks
- Recurrent pneumothorax
- Pneumonia
- Retained hemothorax or empyema
- Importance of careful placement and management of chest drains: