Percutaneous chest tube insertion is routinely performed on surgical wards, in the intensive care unit, in the emergency department, and in pulmonary medicine. While it has been shown that trained physicians can safely perform chest tube insertion, severe complications have been described, associated with a lack of proper training and/or an incorrect insertion or management of chest tubes. The proper technique of thoracic drainage is key for safety and effectiveness. Chest tube insertion has been well described, step by step, in the British Thoracic Society guidelines. The level of scientific proof of these recommendations ranges from a high level of evidence (A) to an expert opinion (C) (see Table 28.1).