The tube can be used to remove clinically undesired substances such as air (pneumothorax),[1] excess fluid (pleural effusion or hydrothorax), blood (hemothorax), chyle (chylothorax) or pus (empyema) from the intrathoracic space.

The concept of chest drainage was first advocated by Hippocrates when he described the treatment of empyema by means of incision, cautery and insertion of metal tubes.

[2] However, the technique was not widely used until the influenza epidemic of 1918 to evacuate post-pneumonic empyema, which was first documented by Dr. C. Pope, on a 22-month-old infant.

Complications that are sometimes associated with chest tubes include the potential for clogging, air leaks, infection, hemorrhage, re-expansion pulmonary edema.

Injury to the liver, spleen or diaphragm is also possible if the tube is placed behind (inferior) to the pleural cavity or is mispositioned.

Chest tube clogging can lead to retained blood around the heart and lungs that can contribute to complications and increase mortality.

[12] Here, digital chest drainage systems can provide real time information as they monitor intra-pleural pressure and air leak flow, constantly.

[13] Keeping vigilant about chest tube clogging is imperative for the team taking care of the patient in the early postoperative period.

Minor complications include a subcutaneous hematoma or seroma, anxiety, shortness of breath, and cough (after removing large volume of fluid).

[citation needed] Subcutaneous emphysema indicates backpressure created by undrained air, often caused by a clogged chest tube or insufficient negative pressure.

[10] When chest tubes are placed due to either blunt or penetrating trauma, antibiotics may decrease the risks of infectious complications.

[5] Chest tubes are also provided in right angle, trocar, flared, and tapered configurations for different drainage needs.

In chest tubes designed for pediatric heart surgery, the EDL is shorter, generally by only having 4 side holes.

The second chamber functions as a "water seal", which acts as a one way valve allowing gas to escape, but not reenter the chest.

Air bubbling through the water seal chamber is usual when the patient coughs or exhales but may indicate, if continual, a pleural or system leak that should be evaluated critically.

An onboard motor is used as vacuum source along with an integrated suction control canister and water seal.

Placement using the Seldinger technique, in which a blunt guidewire is passed through a needle (over which the chest tube is then inserted) has been described.

[citation needed] Chest tube clogging with blood clots of fibrinous material is common.

When this occurs, it can result in retained blood around the heart or lungs that can lead to complications such as hematoma that needs to be drained, effusions, empyema, or, in the long term, fibrothorax.

No conclusive evidence has demonstrated that any of these techniques are more effective than the others, and no method has shown to improve chest tube drainage.

[28] Furthermore, chest tube manipulation has proved to increase negative pressure, which may be detrimental, and painful to the patient.

[32] In December 2018 the European Respiratory Journal published correspondences that raise the possibility of improving mobility as well as patient outcomes by placing a chest tube more optimally.