Bülau

Chest tube
The free end of the Chest Drainage Device is usually attached to an underwater seal, below the level of the chest. This allows the air or fluid to escape from the pleural space, and prevents anything returning to the chest.
ICD-9-CM	34.04
MeSH	D013907
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A chest tube (chest drain, thoracic catheter, tube thoracostomy, or intercostal drain) is a flexible plastic tube that is inserted through the chest wall and into the pleural space or mediastinum. It is used to remove air, (pneumothorax) fluid (pleural effusion, blood, chyle), or pus (empyema) from the intrathoracic space. It is also known as a Bülau drain or an intercostal catheter.

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. However, the technique was not widely used until the influenza epidemic of 1917 to drain post-pneumonic empyema, which was first documented by Dr. C. Pope, on "Joel", a 22-month-old infant. The use of chest tubes in postoperative thoracic care was reported in 1922, and they were regularly used post-thoracotomy in World War II, though they were not routinely used for emergency tube thoracostomy following acute trauma until the Korean War.

Contraindications to chest tube placement include refractory coagulopathy and presence of a diaphragmatic hernia, as well as hepatic hydrothorax. Additional contraindications include scarring in the pleural space (adhesions).

A common complication after thoracic surgery that arises within 30-50% of patients are air leaks. Here, digital chest drainage systems can provide a remedy as they monitor intra-pleural pressure and air leak flow, constantly.

Major insertion complications include hemorrhage, infection, and reexpansion pulmonary edema. Injury to the liver, spleen or diaphragm is possible if the tube is placed inferior to the pleural cavity. Injuries to the thoracic aorta and heart can also occur.