Indications for Tube and Catheter Thoracostomy Pneumothorax that is recurrent, persistent, traumatic, large, under tension, or bilateral Pneumothorax in a patient on positive-pressure ventilation Symptomatic or recurrent large pleural effusion Empyema or complicated parapneumonic effusion Hemothorax Chylothorax Contraindications to Tube and Catheter Thoracostomy Absolute contraindications None Relative contraindications Coagulopathy or bleeding disorder (may require blood products or coagulation factors) Skin or soft tissue infection at the site (a different site without infection should be used if possible) Complications of Tube and Catheter Thoracostomy Malpositioning of the tube in the lung parenchyma, in the lobar fissure, under the diaphragm, or subcutaneously Blockage of the tube due to blood clots, debris, or kinking Dislodgement of the tube, requiring replacement Re-expansion pulmonary edema Subcutaneous emphysema Infection of residual pleural fluid or recurrent effusion Pulmonary or diaphragmatic laceration Intercostal neuralgia due to injury of the neurovascular bundle below a rib Bleeding Rarely, perforation of other structures in the chest or abdomen Equipment for Surgical Tube and Catheter Thoracostomy Equipment for surgical tube thoracostomy Sterile gown, mask, gloves, and drapes Petroleum-based and regular gauze dressings and tape Cleansing solution such as 2% chlorhexidine solution 25 - and 21-gauge needles 10-mL and 20-mL syringes Local anesthetic such as 1% lidocaine 2 Hemostat or Kelly clamps Nonabsorbable, strong silk or nylon suture (eg, 0 or 1 - 0) Scalpel (size 11 blade) Chest tube: Size ranges from 16 to 36 French (Fr) and depends on intended use (20 to 24 Fr for pneumothorax; 20 to 24 Fr for malignant pleural effusion; 28 to 36 Fr for complicated parapneumonic effusions, empyema, and bronchopleural fistula; 32 to 36 Fr for hemothorax).