Absolute: Published guidelines state there are no absolute contraindications for drainage via tube thoracostomy except when a lung is completely adherent to the chest wall throughout the hemithorax, or upon patient refusal.

Relative: Risk of bleeding due to coagulopathies or anticoagulation medications. Whenever possible, coagulopathies and platelet defects should be corrected with the infusion of blood products prior to the procedure. Other relative contraindications include multiple pleural adhesions, emphysematous blebs, and scarring.