Thoracostomy

What is a thoracostomy?

Thoracostomy is a procedure where a surgeon makes an incision (cut) and inserts a tube into your chest. A chest tube drains air or fluid from your pleural space — the space between the thin membranes (pleurae) that line your chest wall and lungs. A needle thoracostomy is an emergency procedure that a healthcare provider uses to treat a tension pneumothorax (when air can get into your lungs but can’t get out) before inserting a chest tube.

What conditions does a thoracostomy treat?

Providers insert a chest tube to drain air or fluid from your chest. Conditions that providers treat with a thoracostomy include:

• Pneumothorax (collapsed lung).
• Pleural effusion (fluid around your lungs).
• Empyema (pus in your pleural space).
• Hemothorax (blood in your chest cavity).
• Chylothorax (lymph in your chest cavity).
• Lung infections.

Is a thoracostomy the same as a chest tube or chest drain?

A thoracostomy is the procedure providers use to put in a chest tube. A chest tube drains fluid or air that accumulates in your chest due to certain medical conditions.

How should I prepare for a thoracostomy?

Sometimes, a thoracostomy is done during medical emergencies and you can’t prepare for it. Other times, your provider will give you instructions on how to prepare. This may include:

• Not taking certain medications before the procedure.
• Changing your medication schedule leading up to the procedure.
• Not eating or drinking a certain amount of time before the procedure.
• Wearing comfortable clothes the day of your procedure.

Tell your provider:

• About any medications you’re taking, including vitamins or supplements.
• If you’re pregnant or think you could be pregnant.
• If you have any allergies to medications.

What happens during a thoracostomy?

Your provider will have you get a chest X-ray or another imaging test before the thoracostomy so they know where to place the tube. During a tube thoracostomy, your provider will:

1. Position you with your head elevated and one arm raised beside your head.
2. Clean and sterilize an area on the side of your chest.
3. Inject a local anesthetic (like lidocaine) to numb the side of your chest. They’ll wait a few minutes after this step to make sure you’re numb.
4. Make a small incision at the side of your chest, between two ribs.
5. Attach a clamp that looks like a pair of scissors or pliers (hemostat) to the opening. (This step isn’t done in every thoracostomy.)
6. Insert a tube through the incision and into your chest. The tube might attach to a drainage container.
7. Apply a sterile dressing (bandage) around the incision.

For a needle thoracostomy, a provider will:

1. Clean and sterilize an area on your upper chest.
2. Insert a needle into your upper chest, between two ribs.

A needle thoracostomy is usually followed by a tube thoracostomy.

How long does this procedure take?

A thoracostomy usually takes about 30 minutes.

What happens after a thoracostomy?

After a thoracostomy, your provider will take another chest X-ray. They’ll also let you know how to take care of yourself and the chest tube. Some instructions may include how to:

• Keep the skin at the incision site clean and dry.
• Take care of the tube and the drainage container. This includes making sure the tube doesn’t get kinked or tangled and keeping the container below chest level.
• Take any prescribed medications.

What are the benefits of a thoracostomy?

Benefits of thoracostomy include:

• It’s minimally invasive.
• It’s useful in emergency situations or to treat chronic conditions.
• It doesn’t require general anesthesia.
• It can make you more comfortable if you have fluid around your lungs that keeps coming back.

What are the risks or complications of a thoracostomy?

Every procedure has some risks, though providers take every precaution to minimize them. Risks of a thoracostomy include:

• Misplacement or dislodging of the tube.
• Infection.
• Subcutaneous emphysema (air accumulating under your skin).
• Re-expansion pulmonary edema (fluid around your lung after it reinflates).
• Bleeding.
• Nerve or tissue damage.

How long does a chest tube stay in?

Some chest tubes stay in only until all the fluid drains. This usually takes just a few days. If fluid keeps coming back because of a chronic condition, you may have a chest tube in for much longer. Ask your provider what to expect.

How long does it take to recover from a thoracostomy?

Once a provider removes your chest tube, it may take three to four weeks for the incision to heal completely. Your provider will give you instructions on how to care for the incision site and whether you need to limit any activities while it heals.

When should I call my healthcare provider?

Contact your healthcare provider if:

• You have signs of infection, including fever, swelling or unexpected pain at the incision site, or color changes to your skin.
• The tubing is twisted or blocked.
• You have any questions about how to take care of the incision site, the tubing or the drainage container.

What is the difference between thoracentesis, thoracotomy and thoracostomy?

A thoracentesis is a procedure that drains fluid or air from your chest. A thoracostomy is a procedure providers use to insert a chest tube (which drains fluid or air from your chest over a few days). A thoracotomy is a more invasive procedure that allows a surgeon to look into your chest cavity to diagnose or treat illnesses. You might have a chest tube put in after a thoracotomy.

A note from Cleveland Clinic

Thoracostomy is a quick, minimally invasive procedure. It can treat serious conditions and help you feel more comfortable if you have a chronic condition that causes fluid to accumulate in your chest. Ask your provider any questions you have about the procedure. They can help you understand what to expect and talk to you about any concerns.