Chest drainage can usually be done with 10-14Fr catheters and is less painful than larger thoracostomy tubes.
Flushing with 20cc saline q12h suggested to maintain patency.
If patient not improved at 48h consider CXR for confirmation of tube placement, and/or CT for tube placement and to identify undrained loculations.
Thoracic surgery consultation should be considered for all empyemas, and for patients who fail to improve with drainage.
Some will eventually require open or thorascopic drainage and debridement