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Intercostal Drainage Care and Management

This document discusses intercostal drainage (ICD) and its management. ICD involves draining fluid, air, blood, or chyle from the pleural space through an intercostal space, and is indicated for conditions like pneumothorax, hemothorax, and empyema. The procedure involves inserting a chest tube in the 5th intercostal space under local anesthesia. The tube is connected to an underwater seal drain and secured. Care of the tube includes dressing changes and monitoring for complications. Potential acute complications include hemorrhage, lung laceration, and organ injury. Late complications can include blockage, retained fluid, or infection. Maintaining tube patency is critical to avoid complications.

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69 views39 pages

Intercostal Drainage Care and Management

This document discusses intercostal drainage (ICD) and its management. ICD involves draining fluid, air, blood, or chyle from the pleural space through an intercostal space, and is indicated for conditions like pneumothorax, hemothorax, and empyema. The procedure involves inserting a chest tube in the 5th intercostal space under local anesthesia. The tube is connected to an underwater seal drain and secured. Care of the tube includes dressing changes and monitoring for complications. Potential acute complications include hemorrhage, lung laceration, and organ injury. Late complications can include blockage, retained fluid, or infection. Maintaining tube patency is critical to avoid complications.

Uploaded by

jerinthomasrajan
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© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

INTERCOSTAL DRAINAGE 

AND

ITS MANAGEMENT

[Link] . [Link]
DEPARTMENT OF CARDIOTHORACIC SURGERY

S.R.M. MEDICAL COLLEGE HOSPITAL 
ANATOMY OF THORAX
ICD – INTERCOSTAL  DRAINAGE

y DEFINITION : THORACOSTOMY

y Drainage of  fluid / air / blood /chyle  from the     
pleural space  through  intercostal space
6
y INDICATIONS y CONTRAINDICATIONS

y PNEUMOTHORAX  y DIAPHRAGMATIC 
HERNIA

y HEMOTHORAX y REFRACTORY 
COAGULOPATHY

y EMPYEMA y SEVERE PLEURAL  
ADHESIONS
y CHYLOTHORAX
y FLAIL SEGMENT  
REQUIRING 
VENTILATOR
DIAGNOSTIC  AIDS
y X‐RAY CHEST

y CT SCAN CHEST

y FAST ULTRASOUNDE 

y CLINICAL SUSPICION INCRITICAL CASES
PURPOSE  

y Diagnostic 

y Therapeutic
TECHNIQUE OF INSERTION

Mostly   EMERGENT  ‐Placement of tube is vital to 

avoid complications
TECHNIQUE
y PAINFUL PROCEDURE

y Usually done under  local  anesthesia

y May need  additional  pain killers
PREPROCEDURE   PLAN
y OBTAIN INFORMED CONSENT

y INFORM THE PATIENT THE POSSIBILITY OF 
MAJOR COMPLICATIONS

y EXPLAIN  THE  MAJOR STEPS OF PROCEDURE 
AND NEED FOR REPEATED XRAYS
MATERIALS NEEDED
y Chest tube with / without trocar

y ICD TRAY – No 11 / 23 Blade with handle, Large Kellys  
clamps, needle  driver, Scissors

y 2‐0 Ethilon / mersilk 

y Mask, gloves & gown 
SITE OF INSERTION
y SAFE  ZONE

y Lateral border of Pectoralis major

y Horizobtal line inferior to Axilla

y Anterior border of Lattisimus 
Dorsi

y Horizontal line  superior to nipple

y 5TH INTERCOSTAL SPACE
POSITION
INCISION
PROCEDURE   ‐ Contd
y Local area preparation 
y Sterile drapings
y Incision along the upper border of the rib
y Curved Clamp is used to develop the tract  & then with 
the finger
y Finger inserted into the pleural space for exploration
y Large bore chest tube (32‐36 F ) is passed along the 
tract into yhe pleural cavity
y Tube is connected to underwater seal & secured with 
sutures
y Check xray to be taken 
INCISION ‐ CONTD
INCISION ‐ CONTD
CHEST TUBE DRAINS
y Available from size       12 F – 36 F

y Large size tube are preferred in case of effusions

y Can be placed with / without  trocar
CHEST DRAIN
UNDERWATER SEAL  DRAIN
y To Allow air to escape through drain                          
BUT NOT TO REENTER

y Always be kept below the level of the patient

y NEVER CLAMP – avoid TENSION PNEUMOTHORAX

y Moderate suction – (‐ 20 cm ) especially in air leak
UNDERWATER SEAL  DRAIN
UNDERWATER SEAL DRAIN
Care of Intercostal tubes 
y DRESSINGS: 
y CHEST XRAY
y OBSERVATIONS: 
y Report immediately chest drainage of >200mls of 
blood in a 1 to 2 hour time frame. 
y *Continuous Sa 02 monitoring. Keep 02 Sa > 96%. 

y *Observe the swings of fluid in the chest tube bottle. 
ICD CARE
y NEVER CLAMP AN INTERCOSTAL TUBE: WHY?? 

y BECAUSE  TENSION PNEUMOTHORAX IF FORGET 
TO REMOVE CLAMP
ASSESS AND REPORT ANY OF THE FOLLOWING
y Sudden drop of Sa 02 < 90% 

y *increased restlessness and anxiety of the patient. 

y *cessation of swing, or swing < 2cm. 

y *absent or decreased breath sounds on the side of the 
pneumothorax. 

y *tympany or hollow sound on chest percussion. 
Contents of the chest bottle

y sterile solution that is not toxic to the lungs 

y Water  /   saline  /   dextrose 
INDICATION FOR REMOVAL
y No Drain

y No Air leak
REMOVAL OF ICD
y Explain procedure to patient and place in a position of 
comfort 

y Remove sterile dressing. Cut suture 

y Ask patient to take a deep breath and hold 

y then remove the tube and place a sterile piece of gauze 
and airtight over the site. 
ACUTE   COMPLICATIONS
y Hemothorax y Tube placed 
subcutaneously
y Lung  laceration y Tube placed too far

y Injury to Diaphragm y Tube falls out

y Stomach  / Colon injury  y Reexpansion  pulmonary 
in unrecognised  edema
Diaphragmatic Hernia
LATE   COMPLICATIONS
y Blockage of tube   ( clot  /  lung  )

y Retained  hemothorax   

y Empyema

y Pneumo thorax   after  tube removal

y Infection  
CONCLUSION
y Emergency life saving procedure

y Maintaining the patency is critical  to avoid 
complicati0ns

y Subcutaneous emphysema          clog /insufficient 
negative pressure

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