Chest tube insertion is a vital, often life-saving procedure which may be required for any patient. A comprehensive knowledge about safe insertion, maintenance and removal of the chest tube is vital for every health-care professional. This article describes essential components of chest tube management such as type of chest tubes, drainage systems, how to perform safe insertion, connecting to the drainage system, fixation of chest tube, precautions during initial drainage, monitoring of patient, daily measurement and emptying of bottle, pain relief, chest physiotherapy, patient transport, method of collecting pleural fluid sample and steps of safe removal.

Background: This study aimed to report the surgical outcomes and also evaluating the safety and feasibility of thoracoscopic pericardial window (PW) for recurrent pericardial effusion. Materials and Methods: This was a retrospective analysis of eight cases of recurrent pericardial effusion, managed by thoracoscopic method in a tertiary-level thoracic surgery centre over 5 years. A detailed analysis of all perioperative variables, including complications, was carried out. Results: A total of eight patients underwent thoracoscopic PW during the study period. Males (87.5%) were predominant in the cohort. The median age was 54 years (range: 28–78 years). The median duration of symptoms was 2 months (range: 1–3 months). Tuberculosis (50%), malignancy (37.5%) and chronic kidney disease (12.5%) were the causes of recurrent effusion. All patients underwent thoracoscopic procedure with no conversions. The median operative time was 45 min (range: 40–70 min). The median effusion volume drained was 500 ± 100 ml. The median hospital stay was 3 days (range: 2–4 days) with no post-procedural complications. All the patients had complete resolution of symptoms. No recurrence was noted in the median follow-up period of 28 months (range: 6–60 months). Conclusions: Thoracoscopic PW is a safe and feasible minimally invasive option in the management of recurrent pericardial effusion in selected patients. Surgical fitness, haemodynamic status and estimated survival (in malignant effusion) should be considered before the procedure.

Background: Few studies have compared the surgical outcomes between tubercular empyema (TE) and nontubercular empyema (NTE), which were limited by a small sample size. We conducted this study with the objective of comparing the surgical outcomes of patients with tuberculous and nontuberculous empyema. Materials and Methods: This is a retrospective analysis of 285 consecutively operated cases of TE and NTE over 5 years conducted in a tertiary care center in New Delhi, India. A comparative analysis of demography, intraoperative, and postoperative variables including mortality between the two groups was carried out. Results: Out of 285 patients, 166 were tubercular and 119 were nontubercular. Nontubercular group had significantly higher age (45.4 ± 17.2 vs. 31.2 ± 13.6 in years), more comorbidities. Procedure was started by thoracotomy in 25.9% of tubercular group and 41.1% of nontubercular group. In patients where procedure started by video-assisted thoracoscopic surgery (VATS), complete decortication could be achieved by VATS in 91.1% of TE patients, whereas it was possible in 77.2% of nontubercular group. Need for postoperative ventilation (10% vs. 1.2%, P = 0.0011) and intensive care unit (ICU) stay (25.2% vs. 3%, P = 0.001) was significantly higher in nontubercular group. Nontubercular group was found to have significantly higher number of complications (13.4% vs. 5.4%, P = 0.02) and postoperative mortality (10% vs. 0, P = 0.001). Conclusions: Higher percentage of TE cases were managed by VATS with reduced operative time, less blood loss, and lower conversions. Need for postoperative ventilation, ICU stay, and complications including mortality were more in NTE.