A Intercostal tube (chest tube) is a hollow, flexible tube placed into the chest. It acts as a drain. The intercostal tube is placed between the ribs and into the space between the inner layer and the outer layer of the chest. This is called the pleural space.
- In all patients on mechanical ventilation
- When pneumothorax is large
- In a clinically unstable patient
- For tension pneumothorax after needle decompression
- When pneumothorax is recurrent or persistent
- Esophageal rupture with gastric leak into pleural space
- When pneumothorax is secondary to chest trauma
- When pneumothorax is iatrogenic, if large and clinically significant
- Malignant pleural effusion
- Treatment with sclerosing agents or pleurodesis
- Recurrent pleural effusion
- Parapneumonic effusion or empyema
- Postoperative care (e.g., after coronary bypass, thoracotomy, or lobectomy)
- The need for emergent thoracotomy is an absolute contraindication to tube thoracotomy.
- Pulmonary bullae
- Pulmonary, pleural, or thoracic adhesions
- Skin infection over the chest tube insertion site
- Loculated pleural effusion or empyema
- Bleeding and hemothorax due to intercostal artery perforation
- Perforation of visceral organs (lung, heart, diaphragm, or intraabdominal organs)
- Perforation of major vascular structures such as the aorta or subclavian vessels
- Intercostal neuralgia due to trauma of neurovascular bundles
- Subcutaneous emphysema
- Reexpansion pulmonary edema
- Infection of the drainage site, pneumonia, and empyema.
- There may be technical problems such as intermittent tube blockage from clotted blood, pus, lines for the insertion of a chest drain or debris, or incorrect positioning of the tube, which causes ineffective drainage.