A chest tube (chest drain, thoracic catheter, tube thoracostomy, or intercostal drain) is a flexible plastic tube that is inserted through the chest wall and into the pleural space or mediastinum. It is used to remove air (pneumothorax), fluid (pleural effusion, blood, chyle), or pus (empyema) from the intrathoracic space. It is also known as a Bülau drain or an intercostal catheter.

The concept of chest drainage was first advocated by Hippocrates when he described the treatment of empyema by means of incision, cautery, and insertion of metal tubes.  However, the technique was not widely used until the influenza epidemic of 1918 to drain post-pneumonic empyema, which was first documented by Dr. C. Pope, on "Joel", a 22-month-old infant. The use of chest tubes in postoperative thoracic care was reported in 1922, and they were regularly used post-thoracotomy in World War II, though they were not routinely used for emergency tube thoracostomy following acute trauma until the Korean War.

The most common complication of a chest tube is chest tube clogging. Chest tube clogging is widely recognized in published surveys of surgeons and nurses. In one study, 100% had seen chest tube clogging, and a majority had seen adverse patient outcomes from chest tube clogging. In a prospective observational study, over 36% of patients had chest tube clogging after heart surgery. Chest tube clogging can lead to retained blood around the heart and lungs that can contribute to complications and increase mortality. If a chest tube clogs when the patient is still bleeding they can become hypotensive from tamponade, or develop a large hemothorax. If there is not enough to cause a mechanical compression of the heart or lungs, the resulting inflammatory response to the retained blood can lead to pleural and pericardial effusions and contribute to the triggering of postoperative atrial fibrillation in susceptible individuals.

A common complication after thoracic surgery that arises within 30–50% of patients are air leaks. If a chest tube clogs when there is an airleak the patient will develop a pneumothorax. This can be life threatening. Here, digital chest drainage systems can provide real time information as they monitor intra-pleural pressure and air leak flow, constantly. Keeping vigilant about chest tube clogging is imperative for the team taking care of the patient in the early postoperative period.

Major insertion complications include hemorrhage, infection, and reexpansion pulmonary edema. Injury to the liver, spleen or diaphragm is possible if the tube is placed inferior to the pleural cavity. Injuries to the thoracic aorta and heart can also occur.

Minor complications include a subcutaneous hematoma or seroma, anxiety, shortness of breath, and cough (after removing large volume of fluid). In most cases, the chest tube related pain goes away after the chest tube is removed, however, chronic pain related to chest tube induced scarring of the intercostal space is not uncommon.

Journal of Intensive and Critical Care Nursing is a newly launched Open access, Peer-reviewed scientific journal which will be dedicated to promote the scientific community dealing with utmost care of critically ill patients in the area of Critical Care Nursing, Intensive Care Medicine, Emergency and Critical Care. Manuscripts can be uploaded online at Editorial Tracking System https://www.scholarscentral.org/submissions/intensive-critical-care-nursing.html or send an email attachment to nursingcare@emedsci.com

zoe kemp
Journal Manager
Journal of Intensive and Critical Care Nursing
Email: nursing@emedicalsci.org