When recovering from an injury to the chest or undergoing lung surgery or sufferng from a collapsed lung, an important part of treatment is to insert a chest tube. This very small but crucial device actioning the removal of air or fluid, or pus from the space around the lungs (pleural cavity) and it enables full lung expansion and subsequent healing.
What happens if the chest tube has to remain inserted longer than expected? In this article, Dr. Kamran Ali will explain why the chest tube drainage may be prolonged, what it implies, and how it is trated to enhance your ability to understand your recovery process.
What Is a Chest Tube and Why Is It Used?
A chest tube (sometimes also called intercostal drain) is a flexible plastic tube that is inserted between the ribs and into the pleural space, which is the area between the lungs and chest wall. It drains air, blood, fluid, or pus to allow the lungs to expand adequately.
Chest tubes are commonly used after:
- Lung or chest or Heart surgery
- Air outside Lungs (pneumothorax)
- Chest trauma or injury
- Pus outside Lungs ( Empyema )
- Water outside Lungs (Pleural Effusion )
- Blood outside Lungs ( Hemothorax)
What Is Considered “Prolonged” Chest Tube Drainage?
Typically, a chest tube remains for 2 to 5 days, depending on your condition, while when it remains for longer than 5–7 days, it is referred to as prolonged chest tube drainage.
It is not always that something has gone wrong — it usually means that your body is taking longer to heal, or that there is some other matter that requires attention.
Why Does Prolonged Drainage Happen?
There are several reasons why a chest tube may need to stay in longer:
1. Persistent Air Leak
This has been one of the most common reasons. Air leaks form if your lung continues to let air out into the pleural space and the lung has not yet sealed adequately. This typically occurs after surgery for lung diseases like Lobectomy, Segmentectomy or Decortication or in patients with fragile lungs (for example, COPD).
2. Excessive Fluid or Pus Accumulation
Continuous accumulation of fluid can occur with pleural effusion, empyema, or tubercular pleuritis, causing the need for prolonged drainage.
3. Incomplete Lung Expansion
Sometimes the lung doesn’t get fully expanded, especially if it’s surrounded by thick pus, fluid, or fibrous tissue. The chest tube remains in longer as part of the treatment.
4. Ongoing Infection
If there’s an ongoing infection in the pleural space (like in an empyema), the chest tube is placed to drain infected fluid. The tube stays in till the infection resolves.
What Happens During This Time?
If your chest tube needs to remain in longer than expected, your doctor will:
- Monitor drainage levels daily
- Check for air leaks
- Perform repeat chest X-rays or CT scans
- Assess lung expansion and healing
- Adjust antibiotics if infection is present
You’ll also be encouraged to move, do breathing exercises, and sit upright often — these help the lungs expand and the drainage process to improve.
When Is Surgery Needed?
In some cases, if the problem doesn’t resolve with time and conservative care, your doctor might suggest a surgical solution. This is more likely in cases of:
- Persistent air leak beyond 7–10 days
- Loculated empyema (pus trapped in pockets)
- Non-expanding lung due to fibrous peel (called trapped lung)
Surgical options include:
- VATS (Video-Assisted Thoracoscopic Surgery) – Minimally invasive and commonly used to seal air leaks, remove infected tissue, or decorticate trapped lung.
- Open thoracotomy – In more complex or severe cases.
At Dr. Kamran Ali’s thoracic surgery practice, we prioritize minimally invasive techniques whenever possible, which means smaller incisions, less pain, and faster recovery.
How Is Recovery Managed?
Recovery with prolonged drainage involves:
- Regular monitoring by your healthcare team
- Proper chest tube care to prevent infection
- Pain management
- Nutritional support to boost healing
- Physiotherapy and breathing exercises
Most importantly, patients are supported with education and emotional care throughout the process.
Final Thoughts
Frustration may mount from having a chest tube for longer than anticipated, yet it could signify that the body needs a little longer to heal-or that the doctors are still working towards the best possible outcome. Almost every patient achieves full recovery after being on drainage for a very long time, with timely interventions and expert care.
At Dr. Kamran Ali’s clinic, we know how important being informed and supported during your recovery period is for you. If you or somebody close to you is battling long chest tube drainage, we will give you holistic care, the best surgical choices, and a peace of mind.
