INTERCOSTALDRAINAGE

AND

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

S.R.M.MEDICALCOLLEGEHOSPITAL

ANATOMYOFTHORAX

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

pleuralspacethroughintercostalspace

y INDICATIONS

y CONTRAINDICATIONS

y PNEUMOTHORAX

y DIAPHRAGMATIC

y HEMOTHORAX

y REFRACTORY

y EMPYEMA

y SEVEREPLEURAL

HERNIA

COAGULOPATHY

ADHESIONS

y CHYLOTHORAX

y FLAILSEGMENT

REQUIRING
VENTILATOR

DIAGNOSTICAIDS
y XRAYCHEST
y CTSCANCHEST
y FASTULTRASOUNDE
y CLINICALSUSPICIONINCRITICALCASES

PURPOSE
y

Diagnostic

Therapeutic

TECHNIQUEOFINSERTION
MostlyEMERGENTPlacementoftubeisvitalto
avoidcomplications

TECHNIQUE
y PAINFULPROCEDURE
y Usuallydoneunderlocalanesthesia
y Mayneedadditionalpainkillers

PREPROCEDUREPLAN
y OBTAININFORMEDCONSENT
y INFORMTHEPATIENTTHEPOSSIBILITYOF

MAJORCOMPLICATIONS
y EXPLAINTHEMAJORSTEPSOFPROCEDURE

ANDNEEDFORREPEATEDXRAYS

MATERIALSNEEDED
y Chesttubewith/withouttrocar
y ICDTRAY No11/23Bladewithhandle,LargeKellys

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

SITEOFINSERTION
y SAFEZONE
y LateralborderofPectoralismajor
y HorizobtallineinferiortoAxilla
y AnteriorborderofLattisimus

Dorsi
y Horizontallinesuperiortonipple

y 5TH INTERCOSTALSPACE

POSITION

INCISION

PROCEDURE Contd
y Localareapreparation
y Steriledrapings
y Incisionalongtheupperborderoftherib
y CurvedClampisusedtodevelopthetract&thenwith

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

INCISION CONTD

INCISION CONTD

CHESTTUBEDRAINS
y Availablefromsize12F 36F
y Largesizetubearepreferredincaseofeffusions
y Canbeplacedwith/withouttrocar

CHESTDRAIN

UNDERWATERSEALDRAIN
y ToAllowairtoescapethroughdrain

BUTNOTTOREENTER
y Alwaysbekeptbelowthelevelofthepatient
y NEVERCLAMP avoidTENSIONPNEUMOTHORAX
y Moderatesuction ( 20cm)especiallyinairleak

UNDERWATERSEALDRAIN

UNDERWATERSEALDRAIN

CareofIntercostaltubes
y DRESSINGS:
y CHESTXRAY
y OBSERVATIONS:
y Reportimmediatelychestdrainageof>200mlsof

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

ICDCARE
y NEVERCLAMPANINTERCOSTALTUBE:WHY??

y BECAUSETENSIONPNEUMOTHORAXIFFORGET

TOREMOVECLAMP

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

pneumothorax.
y *tympanyorhollowsoundonchestpercussion.

Contentsofthechestbottle

y sterilesolutionthatisnottoxictothelungs

y Water/saline/dextrose

INDICATIONFORREMOVAL
y NoDrain
y NoAirleak

REMOVALOFICD
y Explainproceduretopatientandplaceinapositionof

comfort
y Removesteriledressing.Cutsuture
y Askpatienttotakeadeepbreathandhold
y thenremovethetubeandplaceasterilepieceofgauze

andairtightoverthesite.

ACUTECOMPLICATIONS
y Hemothorax

y Tubeplaced

y Lunglaceration

subcutaneously
y Tubeplacedtoofar

y InjurytoDiaphragm

y Tubefallsout

y Stomach/Coloninjury

y Reexpansionpulmonary

inunrecognised
DiaphragmaticHernia

edema

LATECOMPLICATIONS
y Blockageoftube(clot/lung)
y Retainedhemothorax
y Empyema
y Pneumothoraxaftertuberemoval
y Infection

CONCLUSION
y Emergencylifesavingprocedure
y Maintainingthepatencyiscriticaltoavoid

complicati0ns
y Subcutaneousemphysemaclog/insufficient

negativepressure