The procedure is tailored to the underlying condition and patient stability:

1. Before Procedure Evaluation:
   
   • Diagnosis:
     
     • Chest X-ray or CT scan confirms pneumothorax, hemothorax, or effusion.
     • Ultrasound may guide tube placement for loculated effusions.
     • Blood tests assess coagulation (e.g., INR, platelet count) to minimize bleeding risk.
   • Oxygen therapy and IV fluids stabilize the patient if needed.
   • Patients are counseled on the procedure, potential discomfort, and tube management.
2. Surgical Techniques:
   
   • Standard Chest Tube Insertion (Open Thoracostomy):
     
     • Performed under local anesthesia with sedation (e.g., lidocaine, midazolam), or general anesthesia in unstable patients, lasting 15–30 minutes.
     • The patient is positioned supine or semi-reclining, with the affected side elevated.
     • The insertion site is typically in the 4th or 5th intercostal space (between ribs), mid-axillary line (side of the chest), in the “triangle of safety” (bordered by the pectoralis major, latissimus dorsi, and 5th rib).
     • The area is sterilized, and local anesthesia is injected.
     • A small incision (1–2 cm) is made, and blunt dissection with a hemostat creates a tract through the chest wall into the pleural space.
     • A chest tube (size 24–32 Fr for adults, depending on indication) is inserted, directed toward the apex for pneumothorax or base for fluid drainage.
     • The tube is secured with sutures and connected to a drainage system (e.g., underwater seal or suction at -20 cm H₂O).
   • Ultrasound-Guided Insertion:
     
     • Used for loculated effusions or empyema to precisely locate fluid pockets, reducing complications.
   • Pigtail Catheter Insertion (Seldinger Technique):
     
     • For smaller collections (e.g., simple pneumothorax, small effusion).
     • A needle is inserted, followed by a guidewire, and a smaller catheter (8–14 Fr) is placed over the wire.
     • Less invasive, often done at the bedside under local anesthesia.
   • A post-insertion chest X-ray confirms tube placement and lung re-expansion.
3. After Procedure:
   
   • The tube is monitored for drainage (air, fluid, blood) and air leaks (bubbling in the drainage system).
   • Pain is managed with analgesics (e.g., paracetamol, tramadol).
   • Hospital stay varies: 2–5 days for pneumothorax, longer for empyema or hemothorax.
   • The tube is removed once drainage is minimal (<100–200 mL/day), no air leak persists, and lung re-expansion is confirmed on X-ray.