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Intercostal Drainage: Its Management

This document discusses intercostal drainage (ICD), which involves draining fluid, air, blood, or chyle from the pleural space through an intercostal space. ICD is indicated for conditions like pneumothorax, hemothorax, and empyema. The procedure involves inserting a chest tube through an incision in the intercostal space and connecting it to an underwater seal drain to allow drainage while preventing air from reentering. Post-procedure care includes dressing changes, chest x-rays, and monitoring for complications like excessive bleeding or a tension pneumothorax developing if the tube is accidentally clamped.

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Chetan Uniyal
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103 views39 pages

Intercostal Drainage: Its Management

This document discusses intercostal drainage (ICD), which involves draining fluid, air, blood, or chyle from the pleural space through an intercostal space. ICD is indicated for conditions like pneumothorax, hemothorax, and empyema. The procedure involves inserting a chest tube through an incision in the intercostal space and connecting it to an underwater seal drain to allow drainage while preventing air from reentering. Post-procedure care includes dressing changes, chest x-rays, and monitoring for complications like excessive bleeding or a tension pneumothorax developing if the tube is accidentally clamped.

Uploaded by

Chetan Uniyal
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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INTERCOSTALDRAINAGE

AND

ITSMANAGEMENT
DR.V.CHITRALEKA.M.S.M.Ch
DEPARTMENTOFCARDIOTHORACICSURGERY

S.R.M.MEDICALCOLLEGEHOSPITAL

ANATOMYOFTHORAX

ICD INTERCOSTALDRAINAGE
DEFINITION:THORACOSTOMY Drainageoffluid/air/blood/chylefromthe

pleuralspacethroughintercostalspace

INDICATIONS
PNEUMOTHORAX

CONTRAINDICATIONS DIAPHRAGMATIC

HERNIA
REFRACTORY

HEMOTHORAX

COAGULOPATHY
SEVEREPLEURAL

EMPYEMA CHYLOTHORAX

ADHESIONS
FLAILSEGMENT

REQUIRING VENTILATOR

DIAGNOSTICAIDS
XRAYCHEST CTSCANCHEST FASTULTRASOUNDE CLINICALSUSPICIONINCRITICALCASES

PURPOSE

Diagnostic Therapeutic

TECHNIQUEOFINSERTION
MostlyEMERGENTPlacementoftubeisvitalto avoidcomplications

TECHNIQUE
PAINFULPROCEDURE Usuallydoneunderlocalanesthesia Mayneedadditionalpainkillers

PREPROCEDUREPLAN
OBTAININFORMEDCONSENT INFORMTHEPATIENTTHEPOSSIBILITYOF

MAJORCOMPLICATIONS
EXPLAINTHEMAJORSTEPSOFPROCEDURE

ANDNEEDFORREPEATEDXRAYS

MATERIALSNEEDED
Chesttubewith/withouttrocar ICDTRAY No11/23Bladewithhandle,LargeKellys

clamps,needledriver,Scissors
20Ethilon/mersilk Mask,gloves&gown

SITEOFINSERTION
SAFEZONE
LateralborderofPectoralismajor HorizobtallineinferiortoAxilla AnteriorborderofLattisimus

Dorsi
Horizontallinesuperiortonipple

5TH INTERCOSTALSPACE

POSITION

INCISION

PROCEDURE Contd
Localareapreparation Steriledrapings Incisionalongtheupperborderoftherib CurvedClampisusedtodevelopthetract&thenwith

thefinger Fingerinsertedintothepleuralspaceforexploration Largeborechesttube(3236F)ispassedalongthe tractintoyhepleuralcavity Tubeisconnectedtounderwaterseal&securedwith sutures Checkxraytobetaken

INCISION CONTD

INCISION CONTD

CHESTTUBEDRAINS
Availablefromsize12F 36F Largesizetubearepreferredincaseofeffusions Canbeplacedwith/withouttrocar

CHESTDRAIN

UNDERWATERSEALDRAIN
ToAllowairtoescapethroughdrain

BUTNOTTOREENTER
Alwaysbekeptbelowthelevelofthepatient NEVERCLAMP avoidTENSIONPNEUMOTHORAX Moderatesuction ( 20cm)especiallyinairleak

UNDERWATERSEALDRAIN

UNDERWATERSEALDRAIN

CareofIntercostaltubes
DRESSINGS: CHESTXRAY OBSERVATIONS: Reportimmediatelychestdrainageof>200mlsof

bloodina1to2hourtimeframe. *ContinuousSa02monitoring.Keep02Sa>96%.
*Observetheswingsoffluidinthechesttubebottle.

ICDCARE
NEVERCLAMPANINTERCOSTALTUBE:WHY??

BECAUSETENSIONPNEUMOTHORAXIFFORGET

TOREMOVECLAMP

ASSESSANDREPORTANYOFTHEFOLLOWING
SuddendropofSa02<90% *increasedrestlessnessandanxietyofthepatient. *cessationofswing,orswing<2cm. *absentordecreasedbreathsoundsonthesideofthe

pneumothorax.
*tympanyorhollowsoundonchestpercussion.

Contentsofthechestbottle

sterilesolutionthatisnottoxictothelungs

Water/saline/dextrose

INDICATIONFORREMOVAL
NoDrain NoAirleak

REMOVALOFICD
Explainproceduretopatientandplaceinapositionof

comfort
Removesteriledressing.Cutsuture Askpatienttotakeadeepbreathandhold thenremovethetubeandplaceasterilepieceofgauze

andairtightoverthesite.

ACUTECOMPLICATIONS
Hemothorax Lunglaceration InjurytoDiaphragm Stomach/Coloninjury
inunrecognised DiaphragmaticHernia

Tubeplaced

subcutaneously Tubeplacedtoofar
Tubefallsout Reexpansionpulmonary

edema

LATECOMPLICATIONS
Blockageoftube(clot/lung) Retainedhemothorax Empyema Pneumothoraxaftertuberemoval Infection

CONCLUSION
Emergencylifesavingprocedure Maintainingthepatencyiscriticaltoavoid

complicati0ns
Subcutaneousemphysemaclog/insufficient

negativepressure

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