Know More About The Size Of Thoracic Chest Tubes

Tube thoracostomy is the insertion of a tube (chest tube) into the pleural cavity to drain air, blood, bile, pus, or other fluids. At present, the most common tube used for chest drainage is a silastic tube with multiple side holes. It usually has a linear radiopaque stripe running through the most proximal hole (allowing for its location to be identified on chest X-ray) and markings to indicate distance in centimeters from the most proximal hole.

These tubes range in size up to 40 French gauge (Fr). It should be noted that some thoracic tube deployment kits come with a central trochar within the chest tube. Routine use of this trochar is unnecessary, can be dangerous, and is to be discouraged.

The size of the drain depends on the indication for insertion and various other factors. In general, larger drains are more uncomfortable and more difficult to insert with the patient under local anesthesia. Conversely, smaller tubes are usually better tolerated but are more likely to clog with thick fluid or particulate matter as encountered in a hemothorax or empyema. Smaller chest drains are also more prone to drainage problems by obstruction because of kinking of the tubing. 

The location of the tube depends on what is being drained from the pleural cavity. If air is in the pleural space, the catheter tube will be inserted above the second intercostal space at the mid-clavicular line. If there is fluid in the pleural space, the chest tube is inserted at the fourth to fifth intercostal space, at the mid-axillary line.