Unifying Concepts

Indications and Contraindications for Tube Thoracostomy

In current hospital practice chest drains are used in many different clinical settings and doctors in most specialities need to be capable of their safe insertion.

Indications for chest drain insertion

  • Pneumothorax
    • in any ventilated patient
    • tension pneumothorax after initial needle relief
    • persistent or recurrent pneumothorax after simple aspiration
    • large secondary spontaneous pneumothorax in patients over 50 years
  • Malignant pleural effusion
  • Empyema and complicated parapneumonic pleural effusion
  • Traumatic haemopneumothorax
  • Postoperative—for example, thoracotomy, oesophagectomy, cardiac surgery

Contraindications: There are no absolute contraindications to tube thoracostomy, particularly if the patient is in respiratory distress or has a tension pneumothorax. Anticoagulation or a bleeding diathesis is a relative contraindication in a patient undergoing elective chest tube placement for pleurodesis. Blind insertion of a chest tube is dangerous in a patient with adhesions from infection, previous pleurodesis, or a lung transplant; guidance by CT scan without contrast is preferred in these patients.




  1. Laws D, Neville E, Duffy J; Pleural Diseases Group, Standards of Care Committee, British Thoracic Society. BTS guidelines for the insertion of a chest drain. Thorax. 2003 May;58 Suppl 2:ii53-9. [Medline]


Created May 19, 2009

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