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Table 12.5

Indications for Chest Tube Insertion for Parapneumonic Effusions/Empyema

  • Pleural fluid pH <7.20 or pleural fluid glucose <3.3 mmol/L
  • Purulent pleural fluid
  • Pleural fluid positive culture or Gram stain

* The ideal chest drain size is subject to debate but small (<14F) drains may be as effective as larger ones (>14F) in the management of empyema, and cause less pain and discomfort. Regular flushes with normal saline (0.9%) are needed (20 mL four times per day).