Closed chest drainage has been performed since 1800s and has arrived to date by keeping its importance, without too much change in its principals. Chest drainage systems provide one way evacuation of free air and/or fluid accumulated in the pleural cavity due to various aetiologies. Tube thoracostomy is simple but life saving procedure in states of emergency. In the proper indication, it provides a dramatical attenuation in the acute symptoms of illness. Tube thoracostomy provides a safe and effective drainage when performed according to the proper surgical principals. On the other hand, lethal complications may occur during and after tube thoracostomy. Therefore, a thorough knowledge regarding the indications, technical principals, and management of tube thoracostomy would be helpful for understanding the basic applications that prevent complications a priori.