A chest tube is a flexible plastic tube inserted through the chest wall to drain air, blood, or fluid that has collected in the space around your lungs. When something fills that space, your lung can’t expand properly, making it difficult or impossible to breathe. The tube restores normal pressure so the lung can reinflate and function again.
Why the Space Around Your Lungs Matters
Your lungs sit inside a thin double-layered lining called the pleura. Between those two layers is a narrow space that normally contains just a tiny amount of lubricating fluid. This space has negative pressure, almost like a vacuum, which keeps your lungs pulled open against your chest wall every time you breathe.
When air, blood, or excess fluid enters that space, it disrupts the vacuum. The lung on that side can partially or fully collapse, and breathing becomes labored or painful. A chest tube is the primary tool for clearing the space and letting the lung expand again.
Conditions That Require a Chest Tube
The most common reasons for placing a chest tube fall into a few categories based on what’s accumulating in the pleural space:
- Pneumothorax (air leak): Air enters the pleural space, often from a punctured lung. This can happen spontaneously (especially in tall, thin young adults or people with emphysema), after chest trauma, or as a complication of medical procedures like a lung biopsy.
- Hemothorax (blood): Blood collects around the lung, usually after a traumatic injury such as broken ribs, a stabbing, or surgery.
- Pleural effusion (fluid): Excess fluid builds up from conditions like pneumonia, cancer, heart failure, or liver disease. When the fluid is infected (called empyema), drainage becomes urgent.
- Post-surgical drainage: After heart or lung surgery, a chest tube is routinely placed to drain any blood or air that accumulates during recovery.
How the Drainage System Works
The tube itself is only part of the setup. Once inserted, the outer end connects to a drainage system with three chambers, each serving a distinct role. The collection chamber is where fluid or blood accumulates. It’s calibrated so nurses can measure and record how much is draining over time. The water seal chamber acts as a one-way valve: it lets air and fluid flow out of your chest but prevents anything from flowing back in. The suction chamber applies gentle negative pressure to help pull the lung back open against the chest wall.
Together, these three chambers re-create the natural vacuum in the pleural space. You’ll typically see the system sitting on the floor or hanging beside the bed, connected to your chest by tubing. Gentle, steady bubbling in the suction chamber is normal and means the system is working.
Tube Size Depends on What’s Being Drained
Chest tubes range from 5 to 40 French (a unit of catheter diameter), and the size your doctor chooses depends largely on what needs to come out. Thin, watery fluid or air from a simple pneumothorax after a lung biopsy may only require a small 10 to 12 French tube for a day or two. Thicker substances demand more. A hemothorax, where blood is pooling in the chest, may call for a larger tube in the 14 to 28 French range to keep the drainage flowing. Infected fluid collections like empyema typically start with a 14 to 18 French tube.
There’s also an important distinction between traditional large-bore chest tubes and smaller pigtail catheters (named for their curled tip). A meta-analysis of 11 studies involving 875 patients found that pigtail catheters were just as effective as large-bore tubes for treating a collapsed lung. Patients who received the smaller catheters reported significantly less pain, used fewer pain medications, and had shorter recovery times. Current British Thoracic Society guidelines recommend starting with a small-bore tube (14 French or smaller) for draining infected pleural fluid.
What Insertion Feels Like
The tube is placed through a small incision on the side of your chest, generally between two ribs in an area roughly under your armpit. You’ll receive local anesthesia to numb the skin and tissue, and in some cases sedation as well. The procedure typically takes 15 to 30 minutes.
Despite the numbing, most people feel pressure or discomfort during insertion. Pain scores from studies show that smaller tubes cause notably less discomfort. One study found that patients receiving small wire-guided drains reported mild pain, while those with larger tubes (over 20 French) had significantly higher pain scores. Once in place, the tube is stitched to the skin and secured with a dressing.
Living With a Chest Tube
Having a chest tube in place limits your mobility. The drainage system needs to stay upright and below the level of your chest to work properly, so you’ll need to be careful when moving, sitting up, or walking. Nursing staff will regularly check the system, measure drainage output, and look for signs of air leaks (visible as bubbling in the water seal chamber).
Pain at the insertion site is common, and deep breathing or coughing can intensify it. You’ll likely be encouraged to do both anyway, because expanding your lungs helps them heal and prevents complications like pneumonia. Pain medication is adjusted to make this tolerable.
For some patients with a straightforward collapsed lung, a one-way valve (called a Heimlich valve) can replace the bulky three-chamber system. This small, portable device attaches directly to the chest tube and lets air escape without needing a drainage box or wall suction. In a randomized trial of patients with a first-time spontaneous pneumothorax, those given a Heimlich valve returned to normal activities in about 7 days compared to 10 days with standard drainage. They also reported lower pain scores for the first four days, used significantly less pain medication, and found it much easier to get out of bed.
When the Tube Comes Out
The tube stays in until the problem that required it has resolved. For a pneumothorax, that means no air leak has been detected for at least 24 hours and imaging confirms the lung has fully re-expanded. For fluid drainage, removal is typically considered when output drops below 100 to 200 milliliters over 24 hours. Some newer post-surgical protocols allow removal at up to 500 milliliters per day as long as there’s no air leak, infection, or active bleeding.
Removal itself is quick. You’ll be asked to take a deep breath and hold it (or breathe out fully, depending on your care team’s approach) while the tube is pulled out and the site is sealed with a dressing. It’s uncomfortable but brief. A chest X-ray is typically taken afterward to make sure the lung stays inflated and no new fluid has collected.
Possible Complications
Chest tubes are effective but not without risk. A systematic review and meta-analysis broke down complications into categories: about 53% of reported complications involved tube positioning (the tube migrating, kinking, or sitting in a suboptimal spot), 15% were related to the insertion itself (damage to nearby structures), and about 15% were infectious, primarily empyema. Roughly 16% involved problems during removal, including the tube slipping out unintentionally.
Empyema, once a more common concern, has become increasingly rare in recent reports, likely due to improvements in sterile technique and tube management. The most frequent day-to-day issue is the tube becoming blocked by clots or debris, which can slow drainage and may require flushing or repositioning.