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Chest Tube Thoracostomy

Last updated Feb. 5, 2019

Doc James

Large pneumothorax on CT with L sided chest tube in place.


Background Information:

What are the other Names for the Procedure?

  • Chest Drain Placement
  • Intercostal Drain Placement
  • Thoracic Catheter Placement

What is Chest Tube Thoracostomy radiology procedure? (General Explanation)

  • A Chest Tube Placement or a Chest Tube Thoracostomy is a minimally invasive procedure done to drain fluid, blood, or air from the space around the lungs to avoid a lung collapse
  • A thin plastic tube is inserted in a space called the pleural space - the area between the chest wall and lungs - and excess fluid or air is removed from that space
  • A Chest Tube Thoracostomy can also be used to inject medications

What part of the Body does the Procedure involve?

The Chest Tube Thoracostomy procedure is performed in the chest region.

Why is the Chest Tube Thoracostomy radiology procedure Performed?

A Chest Tube Thoracostomy is performed for the following reasons:

  • To resolve pneumothorax (collapsed lung), when air or fluid accumulates in the pleural space due to various lung diseases, such as trauma, cystic fibrosis, COPD, asthma, or lung cancer
  • To resolve hemothorax, where blood accumulates in the pleural space
  • To be used in empyema, where there is an infection in the pleural space with accumulation of pus
  • To be used for pleural effusion, where there is excess fluid due to lung tumors, heart failure, pneumonia, or tuberculosis

What is the Equipment used? (Description of Equipment)

The following equipment is used for a Chest Tube Thoracostomy procedure: A chest tube, CT scan, ultrasound scan, or fluoroscopy with X-ray.

  • A chest tube is a plastic tube; the size of the tube used varies with different procedures

     CT scan:

  • The CT scanner looks like a big box with a hole inside
  • An examination table on which the patient lies down, which slides into the CT scanner
  • X-ray tube and electronic x-ray detectors rotate around the patient

    Ultrasound scan:

  • The equipment consists of a transducer, computer monitor, and other electronics
  • The transducer is used to send high-frequency sound waves in the body. The computer creates images based on the echoes of that sound, returning from the patient’s body

What are the Recent Advances in the Procedure?

There have been no recent advances to replace the Chest Tube Thoracostomy procedure.

What is the Cost of performing the Procedure?

The cost of the Chest Tube Thoracostomy procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

  • It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding a Chest Tube Thoracostomy procedure and what needs to be done
  • If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
  • Also, if the procedure involves multiple steps or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

http://www.thoracic.org/clinical/critical-care/patient-information/icu-devices-and-procedures/chest-tube-thoracostomy.php (accessed on June 7, 2014)

http://www.radiologyinfo.org/en/info.cfm?pg=thoracostomy (accessed on June 7, 2014)

Prior to Chest Tube Thoracostomy radiology procedure:

How does the Chest Tube Thoracostomy radiology procedure work?

The Chest Tube Thoracostomy procedure may be performed either using an ultrasound scan or a CT scan, depending on individual circumstances.

Ultrasound scan:

  • The ultrasound procedure works on similar principles used in sonar by submarines, to determine the size and shape of the object and how far away the object is
  • The transducer sends out high-frequency sound waves in the body. When sound waves echo back from the body, the microphone in the transducer records the changes in the sound.
  • And using the changes in the sound, it is possible to determine the shape, size, or any other changes in the structure of the organ
  • Using the change in the echoed sound, a computer produces a picture in real-time on the screen

CT scan:

  • A CT scan is very similar to taking an X-ray. In an X-ray, radiation passes through the body and an image is recorded on photographic film. The bones appear white, air appears black, and soft tissues appear as gray patches
  • In the CT scan, electronic X-ray detectors and X-ray beams rotate (around the patient) and measure the amount of radiation absorbed
  • The X-ray beam in a CT scan follows a spiral path, as the examination table is moving through the scanner
  • A two-dimensional, cross-sectional image of the body is created by a computer program, by utilizing all the data generated by the scanner. The CT scan produces a very detailed multidimensional view of the body’s interior regions
  • The CT scan produces images of the body, in a way that can be compared to looking at a loaf of bread, by cutting the loaf into thin slices

How is the Chest Tube Thoracostomy radiology procedure Performed?

The Chest Tube Thoracostomy procedure is performed as follows:

  • The patient is placed on the examination table, after being given medications for nausea and pain
  • An intravenous (IV) line is inserted in the patient’s arm to inject medications or anesthesia
  • The catheter insertion area is cleaned and sterilized. The catheter is inserted through the skin and using image guidance from the CT scan or ultrasound, it is sent to the treatment site in the pleural cavity
  • An X-ray is taken to check the correct placement of the chest tube
  • A chest tube is attached to the drainage system (vacuum) and excess fluid, blood, or air, is drained from the chest, and the lungs are fully expanded
  • The patient will be asked to take deep breaths in order to expand their lungs. The lung capacity is tested after removing the fluid using a spirometer
  • After removal of the chest tube, bandage or sutures may be applied and the patient may leave the hospital after a short observation period, on the same day

Where is the Procedure Performed?

A Chest Tube Thoracostomy is performed as an outpatient procedure, at a hospital.

Who Performs the Procedure?

The interventional radiologist usually performs the Chest Tube Thoracostomy procedure.

How long will the Procedure take?

A Chest Tube Thoracostomy procedure usually takes about 30 minutes to perform.

Who interprets the Result?

  • The interventional radiologist determines the success of the procedure and checks to see, if the problem is completely resolved
  • Follow-up visits may be necessary to remove more fluid, for physical checkup, or to check whether the patient has developed any side effects from the procedure

What Preparations are needed, prior to the Procedure?

The following preparations may be needed prior to a Chest Tube Thoracostomy procedure:

  • The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient, including information related to the medications that are being currently taken
  • Do inform the medical professional if you have a history of any medical conditions, such as a heart disease, asthma, diabetes, or kidney disease
  • Do inform the medical professional about any allergies, especially related to barium or iodinated contrast material, which may be used in the procedure
  • It is advisable to wear comfortable and loose clothes. Avoid wearing any metal objects or jewelry, as it may interfere with the scan
  • It is highly recommended to inform your healthcare professional, if you are pregnant or breastfeeding
  • Depending on the procedure adopted, the patient may be asked for certain bowel or bladder preparations, before the preparation sessions
  • An ultrasound is not recommended, if the patient has had a barium enema or GI test in the past two days. This is because any residual barium in the body can affect the ultrasound test
  • The patient may be asked to avoid eating or drinking, several hours before the test
  • The patient may be asked to stop taking any blood thinners, such as aspirin, NSAIDs, before the procedure

What is the Consent Process before the Procedure?

A physician will request your consent for a Chest Tube Thoracostomy procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied with the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What are the Benefits versus Risks, for this Procedure?

Following are the benefits of the Chest Tube Thoracostomy procedure:

  • A Chest Tube Placement is a minimally invasive procedure
  • The procedure requires less hospital stay and is less complicated
  • The X-ray imaging used during the procedure is safe, fast, affordable, and easy to perform

Following are the risks of the Chest Tube Thoracostomy procedure:

  • There is a risk of infection as skin is penetrated for the IV line and for Chest Tube Placement procedure
  • In some cases, the procedure may cause pneumothorax, blood clots, dislodging of the tube, or injury to the chest wall or lungs

What are the Limitations of the Chest Tube Thoracostomy radiology Procedure?

The limitations of the Chest Tube Thoracostomy procedure include:

  • Video-assisted thoracoscopic drainage may be used, if thoracostomy fails
  • In some cases, medications such as fibrinolytics and DNAses are injected through the chest tube for a complete drainage

What are some Questions for your Physician?

Some of the basic questions that you might ask your healthcare provider or physician are as follows:

  • What is the Chest Tube Thoracostomy procedure?
  • Why is this procedure necessary? How will it help?
  • How soon should I get it done? Is it an emergency?
  • Who are the medical personnel involved in this procedure?
  • Where is the procedure performed?
  • What are the risks while performing the procedure?
  • What are the complications that might take place, during recovery?
  • What are the possible side effects from the procedure? How can I minimize these side effects?
  • How long will it take to recover? When can I resume normal work?
  • How many such procedures have you (the physician) performed?
  • Are there any lifestyle restrictions or modifications required, after the procedure is performed?
  • Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
  • Is there any medication that needs to be taken for life, after the procedure?
  • What are the costs involved?

During the Chest Tube Thoracostomy radiology procedure:

What is to be expected during the Chest Tube Thoracostomy radiology procedure?

  • The patient may feel a slight pain when the IV line is inserted in the patient’s arm
  • The patient will feel pressure at the site, when the catheter is inserted

What kind of Anesthesia is given, during the Procedure?

A local anesthetic is usually given during the Chest Tube Thoracostomy procedure.

How much Blood will you lose, during the Procedure?

Since the procedure is a minimally invasive one, the blood loss involved is minimal.

What are the possible Risks and Complications during the Chest Tube Thoracostomy radiology procedure?

The following risks are possible during the Chest Tube Thoracostomy procedure

  • There is a risk of infection as the skin is penetrated during placement of the IV line and due to the Chest Tube Placement
  • In some cases, the procedure may cause pneumothorax, blood clots, dislodging of the tube, or injury to the chest wall or lungs

What Post-Operative Care is needed at the Healthcare Facility after the Chest Tube Thoracostomy radiology procedure?

  • If the patient experiences an allergic reaction to the anesthesia, then they should notify the physician immediately
  • Apart from this, generally there is no post-operative care necessary after the Chest Tube Thoracostomy procedure and the patient may return home after the procedure is performed

After the Chest Tube Thoracostomy radiology procedure:

What is to be expected after the Chest Tube Thoracostomy radiology procedure?

  • If the patient is to be discharged from the hospital after the Chest Tube Thoracostomy procedure and needs to have the chest tube in place, they shall be given specific instructions on:
    • Taking pain medications, antibiotics
    • How to change positions while lying down
    • Taking regular deep breaths followed by a cough
    • And keeping the area around the chest tube insertion, clean and sterilized
  • The patient should inform the physician, if they find the chest tube twisted, bent, or if the connection of the chest tube to the drainage system becomes loose
  • Also, the patient should inform the physician, if he or she experiences any chest pain, trouble breathing, or fever

When do you need to call your Physician?

  • After the Chest Tube Thoracostomy procedure, if the patient experiences an allergic reaction to the anesthesia, then he or she should notify the physician immediately
  • Also, if there is redness or swelling a week after the procedure, the patient should contact the healthcare provider

What Post-Operative Care is needed at Home after the Chest Tube Thoracostomy radiology procedure?

If the patient returns home with the chest tube in place, the patient will be given instructions on how to care for the chest tube and drainage system.

  • The patient may be given antibiotics and pain medication
  • It is recommended that the patient should change positions often while lying down and exercise, if possible. The type and extent of exercises shall be determined by the healthcare provider. Changing the position while lying down is generally recommended to increase drainage from the chest
  • The skin around the region where the chest tube is inserted, should be kept clean and dry
  • The patient should take regular deep breaths followed by a cough
  • The drainage system should be maintained as instructed, keeping it below one’s chest level

If the patient returns home with a tunneled pleural drainage catheter, the patient or care nurse will be instructed on how to care for the tube and the drainage system.

  • Sterile precautions during regular use of the catheter must be taken to reduce the chances of infection
  • The drainage bags should not be reused
  • Also, the patient should not drain more from the chest at one time, than what the healthcare provider recommends. The amount of fluid drained is generally dependent upon the body weight

How long does it normally take to fully recover, from the Procedure?

After the chest tube is removed, normally the patient should fully recover from the procedure within a few days. A small scar may persist though.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The drained fluid will be discarded after the Chest Tube Thoracostomy. However, in some instances, the drained fluid is sent to the pathologist for further analysis.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

  • The fluid drained is processed in the laboratory under a pathologist's supervision
  • Slide(s) are prepared once the fluid is processed and is examined by a pathologist and a pathology report issued
  • Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Chest Tube Thoracostomy radiology procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

  • The hospital, where the procedure is performed
  • A radiologist, performing the procedure
  • Healthcare providers, physicians, who are involved in the process
  • A pathologist (if the drained fluid is sent for analysis)

The patient is advised to inquire and confirm the type of billing, before the Chest Tube Thoracostomy procedure is performed.

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: Dec. 12, 2014
Last updated: Feb. 5, 2019