Always remember

Be careful about the amount of fluid being removed.

Removing excess fluid can cause the child to go into hypovolemic shock



  • Pneumothorax

  • Tension pneumothorax- pneumothorax causing the collapse of the lung due to air accumulation

  • Repeated pneumothorax in spite of needle drainage

  • Ventilated patients

  • Malignant pleural effusion

  • Empyema- generally following abscess of the lung being ruptures or pulmonary tuberculosis



The presentation depends on the age of the child and the hemodynamic stability as well.

Keep a close eye on the following signs

  • Pallor or cyanosis

  • Dyspnoea

  • Increased respiratory rate

  • Reduced breath sounds on the affected side

  • Dullness of percussion

  • Reduced chest movement on the affected side

  • Decreased oxygen saturation

  • Pleuritic chest pain

  • Transillumination in the affected side in pneumothorax- use a torch and touch it to the skin and look for a rim of over 2 cm.

  • Cardiovascular change- tachycardia, decreased blood pressure



  • Before the procedure try to get a chest Xray to confirm the problem.

  • In emergencies, you can use needle decompression to buy time.



  • Decompression by large bore needle (14G-22G)

  • Anterior 2nd intercostal space in the midclavicular line

  • Inset over superior aspect of rib margin

  • A subsequent Chest tube is necessary




Equipment needed

  • Sterile chest tube pack containing gallipot, forceps, scalpel, gauze

  • Suture material

  • Cleaning solution –

  • Sterile gloves

  • Local anaesthetic

  • Syringes and needles

  • Chest drain  and the tubing with a bottle

  • Chest drain clamps and suction pump



  • Position child with affected side up.

  • Entry- 3rd to 5th Intercostal space in mid to anterior axillary line at the level of the nipple.

  • Locally Anesthetise with 1% lidocaine.

  • 1-3 cm incision once intercostal space below desired insertion point and dissect with haemostat until a superior portion of the rib is reached.

  • Push Haemostat on top of rib through Pleural space (not> 1 cm).

  • Spread haemostat and insert a chest tube in the clamp.

  • For pneumothorax- insert tube anteriorly toward apex and for effusion direct tube inferiorly and posteriorly.

  • Attach to drainage system with 20-30 cm H2O pressure.

  • Chest X-ray to confirm position.



  • Confirm fluid in pleural space ( X-ray/Clinically )

  • The child in sitting position/ Supine

  • Anesthetise skin (1% lidocaine) around 7th intercostal space along the posterior axillary line

  • 18-22 G IV catheter attached to syringe into the rib and push through superior aspect of Rib to pleural space with negative pressure until POP

  • Remove fluid for investigations/ symptomatic relief

  • Chest X-ray to rule out pneumothorax

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