Thoracostomy tube is a sterile tube with a number of drainage holes that is inserted into the pleural space. The pleural space is the space between the parietal and visceral pleura, and is also known as the pleural cavity. A patient may require a chest drainage system any time the negative pressure in the pleural cavity is disrupted, resulting in respiratory distress. It is connected to a closed chest drainage system, which allows for air or fluid to be drained, and prevents air or fluid from entering the pleural space. Specific common indications for thoracostomy tubes placement; as Pneumothorax. While coagulopathy is contraindication for its placement. When the nursing team provide their care to patients with thoracostomy tube; they had five priorities, they are closely monitoring of respiratory status, checking underwater seal for bubbles, milking not strip every 2 hours, assess the output color and maintain the chest site cover with sterile occlusive dressing. The management of patient with thoracostomy tube drainage systems need to efficient nursing practice to fully understand what to do in case problems arise. Rapid management for any troubleshooting or complication as potential pneumothorax/respiratory distress, air leak, accidental chest tube removal or chest tube falls out, accidental disconnection of the drainage system, bleeding at the insertion site, drainage suddenly stops and respiratory distress increases, sudden increase in bright red drainage and subcutaneous emphysema. Nurses are responsible for the safe delivery of care so they should be skillful practices about signs and symptoms of troubleshooting thoracostomy tube and interventions for each type.