Royal Hospital, Muscat, Oman Adult ICU — Public Awareness

ICU Procedures — Chest Tube

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Chest tube drainage in ICU

What is a Chest Tube?

Overview

A chest tube (also called a thoracostomy tube) is a flexible plastic tube inserted through the side of the chest wall into the space between the lung and the chest wall — called the pleural space.

It is used to drain air, blood, fluid, or pus that has collected in this space and is preventing the lung from expanding properly. In the ICU, chest tubes are a common and often life-saving intervention.

Why is it needed?

Common reasons

  • Pneumothorax — air trapped in the chest collapsing the lung
  • Haemothorax — blood collecting around the lung
  • Pleural effusion — excess fluid pressing on the lung
  • Empyema — infection and pus in the chest cavity

After surgery

  • Routine drainage after heart or lung surgery
  • Prevention of fluid build-up after thoracic procedures
  • Monitoring of post-operative bleeding
  • Ensuring full lung re-expansion after repair

How is the procedure done?

Step by step

  1. The skin over the insertion site (usually the side of the chest) is cleaned and local anaesthetic is injected to numb the area. Sedation may also be given.
  2. A small incision (cut) is made between the ribs, and the tube is carefully guided through into the pleural space.
  3. The tube is connected to a sealed drainage system — a bottle or chamber that collects what drains out and prevents air or fluid from flowing back in.
  4. The tube is secured to the skin with a stitch and covered with a dressing.
  5. A chest X-ray is taken afterwards to confirm correct placement.
  6. The tube remains in place until drainage stops and the lung has re-expanded, which may be days to a week or more depending on the cause.
While the tube is in place: Your loved one will have the chest tube connected to a drainage system at the bedside at all times. Movement is possible with care. The nursing team checks the tube regularly and records how much fluid drains each hour.

Removing the chest tube

When and how it is removed

The chest tube is removed when the lung has fully re-expanded and drainage has reduced to a safe level — confirmed by a chest X-ray and clinical assessment.

Removal takes only a few seconds. The patient is asked to take a deep breath and hold it, and the tube is pulled out smoothly while the opening is immediately sealed with a dressing. This prevents air from entering.

There may be a brief moment of discomfort, but it is usually quick. Most patients feel significant relief once the tube is removed.

Risks and considerations

Known risks

  • Pain or discomfort at the insertion site
  • Minor bleeding around the insertion point
  • Infection at the skin entry site
  • Tube blockage or displacement (the team monitors for this constantly)
  • Rarely, injury to nearby structures such as blood vessels or the diaphragm
These risks are uncommon and the ICU team is trained to identify and respond to complications immediately. The procedure is only recommended when the benefit clearly outweighs the risk.

Questions to ask the ICU team

  • What is causing the fluid or air build-up in the chest?
  • How long do you expect the tube to stay in?
  • What does the drainage look like and is that normal?
  • What signs should I watch for that something is wrong?
  • What happens after the tube is removed — will there be follow-up imaging?