when to place chest tube for pleural effusion

Do not place chest tube in following scenarios:

  • Patients with simple effusion that has clear cause without signs of infection. E.g. volume overload with bilateral effusions
  • Patients with uncomplicated parapneumonic effusion (simple effusion, uncomplicated, complicated parapneumonic effusion, empyema).
    • small parapneumonic effusion are usually uncomplicated
  • complicated parapneumonic effusions that are too small and difficult to drain (trial of antibiotics first)

Place chest tube in patients with moderate sized, complicated parapneumonic effusion while during diagnostic thoracentesis:

  • parapneumonic effusion with loculations usually won't be drained completely with thoracentesis
  • placing chest tube avoids repeat thoracentesis if not drained completely or if study ends up showing empyema