What Is a Chest Tube?

A chest tube is a hollow plastic tube that is surgically inserted into the chest cavity to drain air or fluid. Different types of fluid, such as blood, pus, or cancer cells, can accumulate in the chest due to trauma, surgery, cancer, or infection.

Chest tubes are often inserted after lung surgery to remove fluids during healing. They can be inserted during surgery, or with local anesthetic while you are awake. Complications may include pain, bleeding, infection, or pneumothorax (collapsed lung). When an air leak or fluid accumulation persists despite having a chest tube in place, other procedures may be done to prevent the re accumulation of fluid or air into the pleural space.

Purpose

A chest tube may be inserted for several reasons:

• To re-expand the lungs after a pneumothorax. For treatment of a pneumothorax, the tube is inserted into the pleural cavity, the space between the pleura (membranes) that line the lungs.
• After surgery for lung cancer to drain fluids that accumulate in the space that's created after a portion of a lung is removed
• For pleural effusions, both benign and malignant
• After heart surgery, to remove fluids that accumulate in the chest.
• If there is a hemothorax (bleeding into the chest), for example, from trauma.
• To drain pus from an empyema (infection or abscess)

With less invasive procedures, such as video-assisted thoracoscopic surgery (VATS), a chest tube may not be needed. When a chest tube is used after VATS, it may be removed sooner (for example, often 48 hours) than after a thoracotomy.

Placement

When a chest tube is inserted for treating a collapsed lung, a small area on the chest is numbed with a local anesthetic. The tube is then inserted, and connected to a machine that uses suction to remove the air, thus allowing the lung to re-expand. The tube is sutured in place so it won’t pull out of place when you move around.

When a chest tube is inserted immediately after surgery, general anesthesia is used in the operating room. The tube is then connected to a container lower than the chest, using gravity to allow the excess fluids to drain.

How Long Are They Left in Place?

The amount of time a chest tube will remain in place can vary depending on the reason it is placed, and how long an air leak or fluid drainage continues.

For example:

• With a pneumothorax, healthcare providers will look at an X-ray to make sure all of the air has been removed, and the lung has expanded completely.
• Following lung cancer surgery, the tube will be left in place until only minimal drainage remains, often a period of three to four days.

Sometimes a leak persists and other treatment options may be considered. Most air leaks will resolve on their own without further treatment.

Removal

Removal of a chest tube is usually a fairly simple procedure than can be done comfortably in your hospital bed without any anesthesia.

The sutures are separated and the tube is then clamped. Your healthcare provider will ask you to take a breath and hold it, and the tube is pulled out. The suture is then tied to close the wound and a dressing applied.

If the tube was placed for a collapsed lung, you may need to have an X-ray to make sure your lung remains expanded after removal.

Complications

The complications of chest tube placement may include:

• Bleeding: Sometimes blood vessels are "nicked" during chest tube insertion. If bleeding persists, surgery may be needed to cauterize the vessels.
• Infection: Any time an instrument is introduced through the skin, there is a small risk of infection. The risk of infection increases the longer the tube is left in place.
• Pain: Sometimes a chest tube may cause pain, pressure, or discomfort. Talk to your doctor about any discomfort that you are having.
• Untreated fluid collection: Some pleural effusions are loculated, which means they have several small collections of water, pus, or blood. When this is the case, a chest tube may only drain that collection of fluid in the area where the chest tube is placed.
• Pneumothorax: A chest tube may puncture the lung, resulting in a pneumothorax. A lung that has been collapsed may also collapse again when the tube is removed.
• Injury: Other structures in the vicinity of the chest tube may be injured, such as the esophagus, stomach, lung, or diaphragm.

Pleural Effusions in People With Cancer

Pleural effusions are very common in people with lung cancer, and commonly occur with metastatic breast cancer as well.

With a pleural effusion, fluid builds up in the pleural space, the area between the two pleural membranes that line the lungs. This space usually contains only the equivalent of three to four teaspoons of fluid. But with lung cancer, several liters of fluid may accumulate, or re-accumulate, quite rapidly.

When cancer cells are present in a pleural effusion, it is termed a malignant pleural effusion. If a malignant pleural effusion is present, it categorizes lung cancer as stage 4.

Recurrent Pleural Effusions

Many people with lung cancer end up having recurrent pleural effusion exerting pressure on the lungs from excess fluid. This causes pain and shortness of breath.

There are many options for treating a recurrent pleural effusion, whether the effusion is benign or malignant.

Shunt Placement

Sometimes a shunt is placed from the pleural space into the abdomen so that the fluid is able to continuously drain. This option may be better than having recurrent thoracentesis (when a needle is placed into this space) to drain the fluid.

A shunt may also be placed to the outside of your body. This allows people to drain their fluid periodically at home without having to return to the hospital each time fluid accumulates. How often the fluid is drained depends on the symptom severity. The effusion is usually drained for comfort and not because it is medically necessary to remove all of the fluid.

Pleurodesis

Another option for treatment of recurrent pleural effusions is pleurodesis, a procedure that scars down the space between the two pleural membranes. This procedure is done in the operating room with the use of general anesthetic. When the layers of the pleura scar together, it obliterates the pleural space so that there is no longer a cavity available for which fluids to collect.

Coping With a Chest Tube

If you need a chest tube, it's important that you are attentive to your symptoms. Talk to your doctor about worsening and improvement of symptoms such as shortness of breath and discomfort, and be sure to watch the amount of fluid that you see draining. These symptoms are all indicators that help determine whether the chest tube is helping and how long you need to keep it in.