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    Intercostal Drainage

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    Putri Adiratna
    This document discusses intercostal drainage (ICD), also known as a thoracostomy. ICD involves draining fluid, air, blood, or chyle from the pleural space through an intercostal space. It indicates ICD for conditions like pneumothorax, hemothorax, empyema, and chylothorax. The document outlines the technique of ICD insertion, including materials needed, site selection in the lateral chest, and connecting the chest tube to an underwater seal drain system below the patient's level. Post-procedure care involves dressing changes, chest x-rays, and monitoring drainage amounts for signs of continued air leak or bleeding.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Intercostal Drainage

    Uploaded by

    Putri Adiratna
    318 views39 pages
    This document discusses intercostal drainage (ICD), also known as a thoracostomy. ICD involves draining fluid, air, blood, or chyle from the pleural space through an intercostal space. It indicates ICD for conditions like pneumothorax, hemothorax, empyema, and chylothorax. The document outlines the technique of ICD insertion, including materials needed, site selection in the lateral chest, and connecting the chest tube to an underwater seal drain system below the patient's level. Post-procedure care involves dressing changes, chest x-rays, and monitoring drainage amounts for signs of continued air leak or bleeding.

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    pre-procedure plan safe triangle materials required

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    intercostal drainage

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    This document discusses intercostal drainage (ICD), also known as a thoracostomy. ICD involves draining fluid, air, blood, or chyle from the pleural space through an intercostal space. It indicates ICD for conditions like pneumothorax, hemothorax, empyema, and chylothorax. The document outlines the technique of ICD insertion, including materials needed, site selection in the lateral chest, and connecting the chest tube to an underwater seal drain system below the patient's level. Post-procedure care involves dressing changes, chest x-rays, and monitoring drainage amounts for signs of continued air leak or bleeding.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    318 views39 pages

    Intercostal Drainage

    Uploaded by

    Putri Adiratna
    This document discusses intercostal drainage (ICD), also known as a thoracostomy. ICD involves draining fluid, air, blood, or chyle from the pleural space through an intercostal space. It indicates ICD for conditions like pneumothorax, hemothorax, empyema, and chylothorax. The document outlines the technique of ICD insertion, including materials needed, site selection in the lateral chest, and connecting the chest tube to an underwater seal drain system below the patient's level. Post-procedure care involves dressing changes, chest x-rays, and monitoring drainage amounts for signs of continued air leak or bleeding.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 39

    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

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