Chest tubes. Indications, technique, management and complications.

O yen the past ten years, the spectrum of diagnostic techniques available to the pulmonary physician has expanded greatly. Fiberoptic bronchoscopy with transbronchial biopsy, transbronchial needle aspiration, and newly developed laser applications exemplify one aspect of the explosion. Percutaneous needle biopsy and thoracoscopy are examples of the wider scope of invasive techniques now employed by the pulmonologist. Present-day care of critically ill patients often requires invasion of the chest vessels for monitoring and administration of nutrients. However, the price of this invasion is a definite incidence of complications, particularly a potentially life-threatening complication, pneumothorax (hemopneumothorax). Traditionally, tube thoracostomy for pneumothorax or hemothorax has been handled by the thoracic surgeon. Today, because of the increased use of invasive procedures by the pulmonologist, those individuals performing such procedures should be competent in tube thoracostomy and principles of management. In addition to emergency placement, elective indications for tube thoracostomy for the pulmonologist include thoracoscopy and pleurodesis of a symptomatic malignant pleural effusion. The purpose of this paper was to (1) review the historic development of tube thoracostomy; (2) discuss technique ofinsertion, drainage systems, and management ofchest tubes; (3) examine individual components and their optimal characteristics; and (4) note the spectrum and incidence of complications associated with the procedure.