Tube thoracostomy: how to insert a chest drain

Chest drain insertion (tube thoracostomy) is an essential skill for hospital doctors dealing with certain pleural diseases. While aspiration may be appropriate in spontaneous pneumothorax and uncomplicated pleural effusions, it is often inadequate. In such cases, and for other indications (Table 1), it may be necessary to insert a chest drain. Traditionally, this is inserted in the pleural space percutaneously through blunt dissection and connected to a drainage device with an underwater seal. The procedure may be image-directed. Newer chest drains based on a guide-wire technique have been developed with the dual aims of safety and ease of appropriate placement.