Chest Drain Placement

Procedures & Monitoring · ICU Decoded chapter 77 · Locked — free with a referral

By Dr Javed Akhtar · Last reviewed 3 October 2026

Cited to BTS guidelines.

Key points

For pneumothorax (tension/large), hemothorax, empyema, or malignant effusion; stay in the triangle of safety.
Most cases need only a small-bore tube (8–14 Fr) placed under ultrasound; reserve large-bore for hemothorax.
Underwater seal, adding suction −10 to −20 cmH₂O if needed; pull when the air leak stops and <100–200 mL/day.
Rapid drainage of large effusions can cause post-expansion pulmonary edema, so clamp at 1–1.5 L.

Investigations

First tests: Bedside respiratory and hemodynamic assessment.

Only if indicated: Lung/pleural ultrasound, Chest X-ray, CT chest.

Repeat monitoring: Oxygenation and respiratory examination.

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