What Size Chest Tube? What Drainage System is Ideal? And Other Chest Tube Management Questions

Michael H. Baumann, MD, FCCP


Curr Opin Pulm Med. 2003;9(4) 

In This Article

Abstract and Introduction


Chest tubes and their accompanying pleural drainage units continue to present challenging questions regarding their optimal use. Appropriate chest tube size selection to accommodate the clinical situation is key, especially in the setting of large pleural air leaks lest a tension pneumothorax ensue. Connection of an appropriate pleural drainage unit to the chest tube is equally important to obviate impeding airflow after successful evacuation by the chest tube. Large-bore chest tubes are generally required for patients with pneumothoraces, regardless of etiology, if the patient is mechanically ventilated, or for patients requiring drainage of viscous pleural liquids such as blood. Smaller bore tubes may be adequate in patients with limited production of pleural air or of free-flowing pleural liquid. Chest tubes may be removed successfully at either end expiration or end inspiration, and potentially as soon as ≤200 mL/fluid output per day is achieved. Additional prospective studies are needed to provide evidence-based answers to the many questions remaining regarding chest tube placement, ongoing management, and removal.

Despite a long history of clinical use, the role and management of chest tubes and accompanying pleural drainage devices remain incompletely defined. The multitude of materials from which chest tubes are made, and design variations incorporated in chest tubes and pleural drainage units (PDUs), and the host of clinical indications for their use, contribute to practice variation in using these devices. Such variation has been documented in recent surveys of practice habit in the management of spontaneous pneumothorax[1] and of malignant pleural effusions.[2]

Two common questions asked by the clinician when incorporating a chest tube and a PDU are what size chest tube to select and what PDU to use. These two issues and several issues addressed recently in the literature are the focus of this article.