What Is a Chest Tube (Thoracostomy)?

Some treatments are about giving the body room to do its own job again, and a chest tube is one of them. When air or fluid collects in the space around the lung, the lung cannot expand fully, and breathing gets harder. A chest tube — the procedure is formally called a thoracostomy — is a flexible tube placed through the chest wall into that space so the air or fluid has somewhere to go. Once it drains, the lung can re-expand, and breathing usually eases.

The video at the top of this page, "Chest Tube Insertion," is a clinical-skills recording of about ten minutes that walks through the main steps of placing one. It is a good companion to this guide because it shows the procedure in order, rather than as a single dramatic moment — and in practice, that order matters.

Step 1: Deciding the tube is needed, and getting ready

A chest tube is used when something is crowding the lung from outside it. Air in the pleural space — a pneumothorax, or collapsed lung — is one common reason; fluid is another, whether that fluid is the kind of effusion covered in our guide to what a pleural effusion is, blood after an injury, or infected fluid. Imaging, usually a chest X-ray and often an ultrasound, confirms what is there and where the tube should go.

Preparation is deliberately unhurried. The patient is positioned so the chosen spot on the chest is accessible, the skin is cleaned, and the area is numbed with local anaesthetic. The team works sterile, with the tube, the drainage unit, and the dressings laid out before anything begins. Because the procedure is often done at the bedside in an emergency or ward setting, that preparation is part of what keeps it safe.

Step 2: Placing the tube

With the area numb, the clinician makes a small incision in the skin and guides the tube through the chest wall into the pleural space, aiming it according to whether air or fluid is being drained. The tube is then secured to the skin so it cannot slip, and the entry point is covered with a dressing. A follow-up chest X-ray is commonly taken to check that the tube sits where it should and that the lung is beginning to re-expand.

Patients often ask whether this hurts. The numbing takes the sharpness out of it, but pressure and a brief pushing sensation are normal, and the team will usually warn you before each part. It is a short procedure — the anchor video's ten minutes gives a fair sense of its pace — though in a difficult case it can take longer.

Step 3: Connecting the drainage system

A chest tube on its own does nothing; it has to lead somewhere. The outer end is connected by tubing to a sealed drainage unit — the clear collection box you can see in the featured photo above, standing beside the bed. Air or fluid drains through the tube into that unit, and the seal stops air from flowing back into the chest. Staff keep the unit below chest level so gravity helps drainage, and they check it regularly: how much fluid has collected, whether air is still bubbling through, and whether the tube is kinked or blocked.

That bubbling is worth understanding, because it worries people. Bubbling in the unit usually means air is still leaving the pleural space — which is the tube doing its job. When the bubbling settles and drainage slows, it is often a sign the lung has sealed and re-expanded. Our second video, "Chest Tube" (about a minute), shows the insertion itself in brief, and is a useful second look after the longer walkthrough above.

Step 4: The days with the tube in place

A chest tube is rarely a one-hour affair. It usually stays in for days while the underlying problem is treated — the air leak sealing, the infection clearing, or the fluid production settling. During that time, deep breathing and coughing matter more than most patients expect: they help the lung re-expand and keep it from stiffening in a partly collapsed state. Nurses and physiotherapists will encourage this, and it is worth doing even when it feels uncomfortable.

You can usually move around with the unit, carefully, and staff will show you how to carry it without pulling the tube. The main things they watch for are a tube that has slipped or become blocked, drainage that suddenly increases, or breathing that gets worse rather than better — any of those should be flagged to the team straight away.

Step 5: Taking the tube out

Removal comes when the job is done: drainage has slowed to a trickle or stopped, air is no longer leaking, and imaging shows the lung re-expanded. The dressing is removed, the securing stitch is cut, and the tube is withdrawn — quickly, often at the end of a breath out — before the small opening is covered with a dressing. Most people describe it as a brief pulling sensation rather than pain. A final chest image may follow to confirm the lung stays expanded without the tube.

So the short answer to the title question is this: a chest tube is a temporary drain that gives a crowded lung its space back. It is placed in a few careful steps, it works quietly through a sealed collection unit over days, and it comes out once the lung can hold its own again.

Frequently Asked Questions

Does having a chest tube put in hurt?

The area is numbed with local anaesthetic, so the sharp pain is taken out of it, but most people feel pressure and a pushing sensation during placement. The team will usually explain each step as it happens.

How long does a chest tube stay in?

Usually days, not hours. It stays until drainage has slowed or stopped, any air leak has sealed, and imaging shows the lung re-expanded. The underlying cause has to be settling too — the tube treats the collection, not the reason it formed.

What is the bubbling in the drainage box?

Bubbling usually means air is still draining out of the pleural space through the tube, which is what the tube is there to do. When bubbling settles and drainage slows, it often signals the lung has sealed and re-expanded.

Can you move around with a chest tube?

Yes, carefully, and staff will show you how to carry the drainage unit without pulling on the tube. The unit is kept below chest level so drainage keeps flowing in the right direction.

When should you call the team urgently?

Flag it straight away if breathing suddenly gets worse, the tube slips out or looks blocked, drainage suddenly increases a lot, or the dressing comes loose. Those are the changes the team most wants to hear about promptly.

MedicalVideos.com has published trusted medical videos since 2007. The site was founded by Dr. Mohamed Ibrahim, MD, PhD — physician-scientist.

Educational only — this article is general information about chest tubes, not medical advice and not a diagnosis. If you are suddenly very breathless or struggling to breathe, seek medical care promptly and discuss your symptoms with your own doctor.