Thoracic ultrasound is a powerful diagnostic imaging technique for pleural space disorders. In addition to visualising pleural effusion, thoracic ultrasound also helps clinicians to identify the best puncture site and to guide the drainage insertion procedure. Thoracic ultrasound is essential during these invasive manoeuvres to increase safety and decrease potential life-threatening complications. This paper provides a technical description of pigtail-type drainage insertion using thoracic ultrasound, paying particular attention to indications, contraindications, ultrasound guidance, preparation/equipment, procedure and complications.