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Intercostal Drainage

Intercostal drainage (ICD) is a medical procedure for draining air, fluid, or pus from the pleural space, indicated for conditions like pneumothorax, pleural effusion, and empyema. The procedure involves obtaining informed consent, proper positioning, local anesthesia, and careful insertion of a chest tube, followed by monitoring for complications. Post-procedure care includes monitoring respiratory status, drainage function, and pain management, with chest X-rays to confirm proper tube placement.

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0% found this document useful (0 votes)
23 views5 pages

Intercostal Drainage

Intercostal drainage (ICD) is a medical procedure for draining air, fluid, or pus from the pleural space, indicated for conditions like pneumothorax, pleural effusion, and empyema. The procedure involves obtaining informed consent, proper positioning, local anesthesia, and careful insertion of a chest tube, followed by monitoring for complications. Post-procedure care includes monitoring respiratory status, drainage function, and pain management, with chest X-rays to confirm proper tube placement.

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Neethupaul
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INTERCOSTAL DRAINAGE

The intercostal drainage (ICD) procedure, also known as chest tube insertion, is a
medical procedure used to drain air, fluid, or pus from the pleural space (the space between
the lungs and the chest wall).
Purpose
 To drain pneumothoraxes or effusions from the intrathoracic space
Indications for Intercostal Drainage:
1. Pneumothorax – Air trapped in the pleural space.
2. Pleural Effusion – Fluid accumulation in the pleural space (e.g., from heart failure,
infection, cancer).
3. Hemothorax – Blood in the pleural space, often due to trauma.
4. Empyema – Pus in the pleural space, typically caused by infection.
5. Post-operative care – After chest or thoracic surgery to remove air or fluid build-up.
Preparation for the Procedure:
1. Informed Consent:
 Obtain informed consent from the patient (if possible) or their family. Explain the
procedure, its risks, and benefits.
2. Positioning:
 The patient is usually positioned either sitting upright or lying on their back with the head
of the bed elevated (semi-recumbent). In some cases, the patient may be positioned on the
side where the tube is to be inserted.
3. Sterilization and Local Anaesthesia:
 Clean the site of insertion with antiseptic solution (e.g., chlorhexidine).
 Local anaesthesia (e.g., lidocaine) is administered around the insertion site to numb the
area and reduce discomfort.
4. Supplies:
 Chest tube (typically 20-28 French size depending on the patient and condition).
 Sterile gloves and drapes.
 Scalpels, forceps, and sutures.
 Drainage system (e.g., underwater seal or suction device).
 Syringes for anaesthesia and local agents.
 Sterile dressing.
Procedure
1. Identify the Insertion Site:
 The typical site for intercostal drainage is the 5th intercostal space in the mid-axillary
line (around the level of the nipple for adults). The exact site depends on the underlying
condition.
 The procedure is done above the rib, because the intercostal vessels and nerves run along
the lower border of each rib. This helps to avoid injury to these structures.
2. Sterilization and Drape:
 The skin around the insertion site is thoroughly cleaned and sterilized.
 A sterile drape is placed over the area to maintain aseptic technique.
3. Local Anaesthesia:
 An anaesthetics (usually lidocaine) is injected into the skin and deeper tissues to numb the
area. Additional anaesthetics is infiltrated along the path of the chest tube insertion to
ensure the procedure is painless.
4. Incision and Dissection:
 A small incision (usually about 2-3 cm) is made in the skin between the ribs.
 Using blunt dissection, the muscles and tissues between the ribs are separated to expose
the pleural cavity. Care is taken not to damage vital structures.
5. Chest Tube Insertion:
 The chest tube is introduced through the incision into the pleural space. This is done using
a sterile technique to prevent infection.
 The tube is advanced into the pleural cavity, ensuring that the tip of the tube is in the
correct location, either to drain air, fluid, or both.
6. Securing the Tube:
 Once the chest tube is properly positioned, it is secured in place with sutures or a special
securing device to prevent displacement.
 The tube is then connected to a drainage system (either a water seal or a suction
drainage system depending on the clinical situation).
7. Post-Insertion Monitoring:
 After insertion, the tube is checked for correct placement, and the drainage system is
monitored for air or fluid output.
 The patient's vital signs (e.g., blood pressure, heart rate, oxygen saturation) should be
closely monitored, and chest X-rays are often performed to confirm the proper placement
of the tube and evaluate for any complications (like a new pneumothorax).
Post-Procedure Care:
 Monitoring:
 Continuous monitoring of the patient’s respiratory status and vital signs is crucial,
particularly for signs of infection or further respiratory distress.
 Drainage Monitoring:
 Observe the drainage system for correct function. Fluid should be draining freely from the
chest tube, and air bubbles in the water-seal chamber may indicate an air leak.
 Pain Management:
 Adequate pain relief (e.g., analgesics) should be provided as the procedure can cause
significant discomfort.
Chest X-ray:
 A follow-up chest X-ray is often performed to ensure that the chest tube is correctly
positioned and that there is no further build-up of air or fluid in the pleural space.
Removal of Chest Tube:
 The chest tube is typically removed once the condition that required the drainage (e.g.,
pneumothorax, pleural effusion) has resolved, and no further drainage is needed. The
procedure for removal involves clamping the tube for a short period to check for any
pneumothorax, and then it is gently withdrawn.
Possible Complications:
1. Infection – Any invasive procedure carries a risk of infection, especially in the
pleural space.
2. Bleeding – Injury to blood vessels or organs can occur during insertion, leading to
bleeding.
3. Pneumothorax – If not already present, the procedure could inadvertently cause a
pneumothorax.
4. Organ Injury – Accidental injury to the lung, diaphragm, liver, or spleen may occur
if the chest tube is inserted improperly.
5. Malpositioning – The chest tube could become displaced or incorrectly positioned,
leading to inadequate drainage.
6. Air Leaks – Persistent air leaks from the pleural cavity can prolong the need for a
chest tube

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