Unifying Concepts

Indications and Contraindications for Tube Thoracostomy

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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