Needle aspiration or chest tube insertion

If a larger area of your lung has collapsed, it's likely that a needle or
chest tube will be used to remove the excess air.

Needle aspiration. A hollow needle with small flexible tube (catheter) is

inserted between the ribs into the air-filled space that is pressing on the
collapsed lung. The needle is removed and a syringe is attached to the
catheter so that the doctor can pull out the excess air. The catheter may
be left in for a few hours to ensure the lung is re-expanded and the
pneumothorax does not recur.
Chest tube insertion. A flexible chest tube is inserted into the air-filled
space and may be attached to a one-way valve device that continuously
removes air from the chest cavity until your lung is re-expanded and
healed.
Nonsurgical repair
If a chest tube doesn't re-expand your lung, nonsurgical options to close
the air leak may include:

Using a substance to irritate the tissues around the lung so that they'll
stick together and seal any leaks. This can be done through the chest
tube, but may be done during surgery.
Drawing blood from your arm and placing it into the chest tube. The
blood creates a fibrinous patch on the lung (autologous blood patch),
sealing the air leak.
Passing a thin tube (bronchoscope) down your throat and into your lungs
to look at your lungs and air passages and place a one-way valve. The
valve allows the lung to re-expand and the air leak to heal.
Surgery
Sometimes surgery may be necessary to close the air leak. In most
cases, the surgery can be performed through small incisions, using a
tiny fiber-optic camera and narrow, long-handled surgical tools. The
surgeon will look for the leaking area or ruptured bleb and close it off.

What Is a Chest Tube?

A chest tube is a plastic tube that is used to drain fluid or air from the
chest. Air or fluid (for example blood or pus) that collects in the space
between the lungs and chest wall (the pleural space) can cause the lung to collapse. Chest tubes can be inserted at the end of a surgical procedure
while a patient is still asleep from anesthesia or at the bedside using a local pain killer and some sedation. Chest tubes come in a variety of shapes
and sizes. Depending on what they are needed for, they can range in diameter from as small as a shoelace to as large as a highlighter.

Chest tubes are usually connected to drainage systems that collect fluid and allow air to escape from the chest. These systems can be allowed to
drain passively or can have suction applied to them.

What to Expect
When chest tubes are placed in a patient who is awake, patients can expect to receive some form of local pain killer where the chest tube will be
inserted. Often, patients are also given medicine to help ease anxiety. Although efforts are made to make the procedure more tolerable, patients still
usually experience some discomfort. Some chest tubes are inserted after the skin and muscles of the chest wall are cut and gently spread apart.
Some chest tubes are inserted after a wire is placed into the chest through a needle and the wire acts as a track for the tube to follow. In both
cases, patients often report some discomfort after the procedure as the tube lies on the ribs and moves slightly with each breath. Luckily, this
discomfort is usually temporary.

The main goal of this procedure is drainage of the pleural space. Patients can expect to see or feel the fluid or air leaving the chest. Often, patients
may feel the collapsed lung re-expanding. A chest X-ray will be performed after the procedure to see how much air or fluid has been drained, how
much the lung has re-expanded, and to determine the final position of the chest tube. Chest tubes remain in place for a variable number of days.
Usually, when the amount of fluid draining from the tube is low, or there is no more air escaping through the tube, it can be removed.

Like any surgical procedure, the primary risks with chest tube placement are bleeding and infection. Practitioners are careful to avoid the blood
vessels that run on the underside of the ribs during placement. In order to avoid introducing an infection, the entire procedure is performed in a
sterile fashion. The other major risks involve damage to the other structures in the chest, like the lungs and heart. Though injuries to these
structures are very uncommon, they can be serious.

Understanding the Results

Chest tubes are kept in place by stiches and are covered by a sterile dressing. Mild discomfort at the site of insertion is common. If you have severe
pain or difficulty breathing, call for help right away. The duration for which a chest tube is needed varies but is usually a few days. In certain
situations, patients can be sent home with a chest tube; however, in most cases they are removed before discharge from the hospital. Your
healthcare provider will remove the chest tube by cutting the stiches that hold it in place. Mild discomfort during removal may occur.

What Are the Risks?

Pain during insertion and after placement of chest tube
Although pain during insertion and mild discomfort after placement are common, your healthcare provider can help minimize these effects with pain
medicines.
Infection
Improper placement
Dislodged chest tube
Collapsed lung after removal of chest tube
Bleeding at the site of insertion
Bleeding into the pleural space (space around lungs) or within the abdomen
Injury to the lung
Injury to other organs, such as heart, spleen, liver, diaphragm