Chest Tube for a Collapsed Lung
Releasing Trapped Air and Blood So the Lung Can Expand
Why Does a Lung Collapse?
On television, a chest tube looks dramatic. Someone cannot breathe. A sharp instrument enters the chest. Air rushes out. The patient suddenly improves. While that version is simplified, the emergency it portrays is very real. When air escapes the lung and becomes trapped in the space between the lung and the chest wall, it is called a pneumothorax. Air belongs inside the lung, not outside it. When enough air accumulates in that outer space, it compresses the lung and prevents it from expanding normally.
Under normal conditions, the chest cavity operates on negative intrathoracic pressure, a subtle vacuum effect that keeps the lungs inflated. When you inhale, your diaphragm moves downward and your chest wall expands, lowering the pressure inside the chest so air naturally flows in. That pressure difference is what allows the lungs to stay open against the chest wall. If air leaks into the pleural space, that balance is disrupted. The vacuum effect disappears, pressure builds where it should not, and the lung collapses inward instead of expanding outward.
When Does It Become Dangerous?
A small pneumothorax may cause mild shortness of breath and can sometimes be observed. But when air continues to build and cannot escape, pressure rises. That pressure can collapse the lung completely and even shift the windpipe and compress the heart. This is called a tension pneumothorax, and it is a true emergency.
Trauma adds another layer. Rib fractures can puncture lung tissue. Blood vessels can tear. Blood may collect in the chest cavity, known as a hemothorax. When both air and blood are present, it is called a hemopneumothorax. In all of these situations, something must evacuate that trapped air or blood so the lung can re-expand.
What Is a Chest Tube?
A chest tube is a sterile, flexible plastic tube placed into the chest cavity to remove air, blood, or fluid. Think of it less as a weapon and more as a controlled drainage system. Its job is simple: allow what does not belong there to escape.
The tube connects to a sealed drainage system that often includes suction. As air or blood leaves the chest, pressure decreases. Once the abnormal pressure is relieved, the lung can expand again naturally. The body does the healing. The tube simply gives it the chance.
Where Does It Go?
Placement requires careful attention to anatomy. We typically insert the tube along the mid axillary line, between the ribs, usually around the fourth or fifth intercostal space. That location avoids vital structures and gives safe access to the pleural space. We numb the area thoroughly with local anesthetic before making a small incision.
Blunt dissection is used to gently separate tissue layers until we enter the pleural cavity. We guide the tube into position and confirm placement when air or fluid begins to drain. The tube is secured with sutures and connected to a one way drainage system so outside air cannot enter. This is controlled, deliberate, and guided by landmarks, sometimes ultrasound, and often confirmed by chest X ray.
What Are the Risks?
This is not a casual procedure. Beneath the right chest lies the liver. Beneath each rib runs an intercostal artery, vein, and nerve. Misplacement could injure those structures. There is also risk of bleeding, infection, or accidental lung injury if technique is careless.
That is why a chest tube is placed with focus and respect. When done correctly for the right indication, it can be lifesaving within minutes. When not needed, it is not done. Like many emergency procedures, timing and judgment matter just as much as skill.
THE BOTTOM LINE
• A chest tube removes trapped air or blood from the chest so the lung can expand
• It treats emergencies like pneumothorax, tension pneumothorax, and hemothorax
• It is powerful, precise, and used when pressure inside the chest cannot wait
Written by a Board-Certified Emergency Medicine Physician