At a glance
Chest tube insertion, also called water-seal drainage (WSD), is a procedure in which a flexible plastic tube is placed through the chest wall into the pleural space (the narrow gap between the lung and the chest wall) to drain unwanted fluid, air, or blood that has built up there.
Normally the pleural space contains only a thin film of fluid that lets the lung slide smoothly as you breathe. When air, excess fluid, or blood collects in that space, it presses on the lung and prevents it from expanding fully. The tube is connected to a sealed water chamber that works like a one-way valve, letting air and fluid drain out while blocking anything from flowing back in. Once the build-up is cleared, the lung can re-expand and breathing becomes easier.
Medical Condition
Chest tube insertion is used whenever air, fluid, blood, or pus has collected in the pleural space in a quantity that is causing breathing difficulty, low blood pressure, or is likely to do so without treatment.
- Pneumothorax (a collapsed lung caused by air leaking into the pleural space), including tension pneumothorax, which is a medical emergency.
- Haemothorax (blood in the pleural space), often from a chest injury or after surgery.
- Pleural effusion (a large build-up of fluid around the lung) that is causing shortness of breath and has not responded to medication alone.
- Empyema (a pocket of pus in the pleural space) caused by a severe lung infection.
- Chylothorax (a build-up of lymphatic fluid, which is milky-white in colour) following chest surgery or injury to lymph vessels.
- Post-operative drainage after heart, lung, or oesophageal surgery to prevent fluid from accumulating while the chest heals.
This procedure is not suitable for everyone. Doctors are cautious in certain situations and will weigh the risks carefully before proceeding.
- Patients who have very abnormal blood clotting and cannot be stabilised before the procedure.
- Cases where the fluid or air is trapped in an unusual location and a tube cannot be placed safely without image guidance.
- Patients who have had previous chest surgery on the same side, where scar tissue (adhesions) may make safe tube placement difficult without specialist techniques.
Risks & Complications
Chest tube insertion is a common and well-established procedure, but like any intervention that enters the body, it carries recognised risks.
- Pain or discomfort at the insertion site, which is the most frequently reported experience.
- Incorrect tube position, where the tube ends up in the wrong part of the chest or does not drain effectively.
- Infection at the skin entry point or, less commonly, inside the pleural space itself.
- Bleeding around the insertion site or, rarely, injury to a blood vessel.
- Injury to nearby structures such as the lung, diaphragm (the muscle under the lungs), liver, or spleen, particularly if insertion landmarks are not identified carefully.
- Subcutaneous emphysema (air leaking under the skin, causing a crackling sensation when touched), which usually resolves on its own.
- Tube blockage or kinking, which can prevent drainage from working properly.
- Re-expansion pulmonary oedema (fluid building up in the lung tissue when the lung re-expands very quickly), a rare complication that requires close monitoring.
- Persistent air leak, where air continues to escape from the lung even after the tube is in place.
Preparation & Procedure
When the procedure is planned in advance, the medical team will give specific instructions. In emergency situations, preparation is shortened because acting quickly is the priority.
For planned insertions, patients are usually asked to stop eating and drinking for several hours beforehand, since mild sedation or local anaesthesia (numbing medicine injected into the skin) will be used. Blood-thinning medicines may need to be paused for a period decided by the doctor. Smoking should be avoided, as it affects lung function and healing. The team will ask about all current medicines and any allergies.
Before the procedure, the medical team typically runs several tests to understand the exact location and nature of the problem and to check that the patient is safe to proceed.
- Chest X-ray to confirm the presence and rough location of air or fluid.
- Ultrasound (USG) of the chest, often used to mark the safest insertion point, especially for fluid.
- CT scan of the chest in complex cases where the anatomy or the location of the collection is unclear.
- Blood tests to check clotting ability, blood cell counts, and kidney function.
- Oxygen level monitoring using a pulse oximeter (a clip placed on the finger).
The procedure itself follows a consistent sequence, though the exact number of steps and their details vary between hospitals and whether the case is an emergency or planned.
- 1. The patient is positioned, usually lying on their back or side, with the arm on the affected side raised to open up the ribcage.
- 2. The skin on the side of the chest (usually in the area under the armpit or slightly lower) is cleaned with antiseptic solution.
- 3. Local anaesthetic is injected into the skin and deeper tissue to numb the area. Sedation may also be given to help the patient relax.
- 4. A small cut is made through the skin between two ribs.
- 5. A path is created through the chest wall using a blunt instrument, and the doctor confirms entry into the pleural space.
- 6. The chest tube is guided through the opening and positioned so its drainage holes sit inside the pleural space.
- 7. The tube is secured to the skin with a stitch and dressing to prevent it from moving.
- 8. The outer end of the tube is connected to the water-seal drainage system, and the team confirms that drainage is flowing correctly.
- 9. A chest X-ray is taken to verify the tube position.
Aftercare
After the tube is placed, patients stay in a hospital ward or intensive care unit (ICU) for monitoring, because the underlying condition that required the tube needs ongoing care alongside the drainage itself.
- The drainage system is checked regularly by nurses: the water in the seal chamber is watched for bubbling, which shows air is still escaping, and the volume and colour of fluid drained is recorded.
- Chest X-rays are taken at intervals to track whether the lung is re-expanding as expected.
- Pain at the tube site is managed with pain-relieving medicines; telling the nurse about any increase in pain helps the team respond quickly.
- Movement is usually encouraged as tolerated, though the drainage system must stay upright and below chest level at all times to keep the seal working.
- The tube site dressing is changed regularly using a sterile technique to reduce infection risk.
- The tube is removed once drainage drops to a low level, air leaks have stopped, and the chest X-ray confirms the lung has re-expanded. This is a brief bedside procedure.
- After removal, a follow-up chest X-ray is taken to confirm the lung remains expanded.
- Patients are typically advised to avoid heavy lifting and strenuous activity for a period after discharge, with the exact duration depending on the original condition and how the body healed.
- A follow-up appointment with the respiratory medicine team is usually arranged within a few weeks to review recovery and address any underlying disease.
Cost & What Determines It
The cost of chest tube insertion and the associated hospital stay varies widely depending on how the procedure is done, why it is needed, and where the patient receives care.
- Severity and complexity of the underlying condition: a straightforward pneumothorax in an otherwise healthy person typically requires a shorter hospital stay than an infected pleural space or a haemothorax after trauma.
- Whether imaging guidance (USG or CT scan) is used during insertion, which adds to the procedural cost but improves safety in difficult cases.
- Type of chest drain used: different tube designs and drainage systems carry different price points.
- Length of hospital stay: the tube often remains in place for several days, and each additional day of monitoring, nursing care, and repeat X-rays contributes to the total bill.
- Ward level: costs differ between a general ward, a high-dependency unit, and an ICU, and patients may move between these as their condition changes.
- Country and hospital class: the same procedure costs more in some countries than others, and private hospitals charge more than public hospitals.
- Laboratory and imaging tests run before, during, and after the procedure.
- Medicines given during the admission, including pain relief, antibiotics if an infection is present, and treatment for the underlying condition.
- Specialist fees: respiratory physicians, surgeons if involved, and anaesthetists may each bill separately.
Hospital packages abroad often bundle the procedure itself, the operating or treatment room fee, basic nursing care, and a set number of inpatient days. What tends to be billed separately includes additional days beyond the package, extra imaging, specialist consultations beyond the primary team, medications, and any complication management that requires a change in care level.
BPJS Kesehatan and most Indonesian private health insurance policies do not cover treatment carried out in another country, so patients travelling abroad for this procedure usually pay the full cost from their own funds or through a private international health insurance policy that explicitly includes overseas hospital care. Before travelling, asking the hospital for a detailed written cost estimate covering the most likely scenarios, including a possible extended stay if drainage takes longer than expected, is the most reliable way to plan the budget and avoid unexpected charges.
Frequently Asked Questions
How many sessions does chest tube insertion (WSD) require?
Chest tube insertion is a single procedure, but the tube usually stays in place for several days until the fluid, air, or blood draining from around your lung has cleared. Your doctor checks the drainage each day and removes the tube once your lung has re-expanded and output is low enough to be safe.
What does it feel like to have a chest tube inserted and while it is in?
Before insertion, doctors inject a local anaesthetic (numbing medicine) into the skin and deeper tissue, so the sharpest part of the procedure feels more like firm pressure than pain. Once the tube is in, most people feel a dull ache or tightness in the chest, and moving or coughing can cause a short, sharper sensation. Pain relief is given regularly to keep you comfortable while the tube drains.
How soon will I feel better after a chest tube (WSD) is inserted?
Many patients notice that breathing becomes easier within the first few hours as fluid or trapped air is drained away from the lung. Full improvement depends on what caused the problem in the first place, such as infection, a collapsed lung, or fluid build-up, and on how quickly your body responds to treatment. Your doctor will track your progress with regular chest X-rays and adjust the plan if needed.
How much does chest tube insertion (WSD) cost?
The cost depends on several factors specific to your situation, including how long the chest tube needs to stay in, the type of ward or room you stay in, any additional tests such as X-rays done during that period, and whether other treatments are needed at the same time. The clearest way to get a real number is to request a written cost estimate from the hospital before your procedure.
This page is general information, not a substitute for medical advice. Every case is different. Your doctor decides what is right for you.
