Intercostal Drainage
Short Note
Definition
Intercostal drain /chest drain / pleural drain/under water seal drainage
Flexible tube inserted through intercostal space into the pleural cavity and the distal end of the tube is immersed in sterile wate to seal the tube so that air will not enter the pleural cavity
Purpose : draining pneumothorax, pleural effusion, empyema
Indications
Pneumothorax greater than 2 cm after 2 attempts at aspiration
Pleural effusion causing breathlessnesss
Empyema
Tension pneumothorax after needle decompression
Palliation of breathlessness in malignant pleural effusions
To facilitate pleurodesis
To drain haemothorax
Chylothorax
Post-operativ - thracotomy, oesophagectomy, cardiac surgery
Contraindications
Coagulopathy
Diaphragmatic hernia
Hepatic Hydrothorax
Scarring in the pleural space (adhesions)
Local infection
Complications
Haemorrhage
Pneumothorax
Infection - empyema
Subcutaneous emphysema (surgical emphysema)
Retained blood syndrome
Reexpansion pulmonary oedema
Subcutaneous haematoma/seroma
Intercostal scar pain
Procedure
Study ches X-ray
Local Anaesthesia
In the safe zone
Aseptic precautions followed- into the 5th intercostal space slightly anterior to the mid axillary line
Small incision over intercostal space -
Chest Tube Management
No loops, no kinks, no obstructions
Maintain patency - by milking, stripping, fan folding, tapping
Underwater seal to be strictly maintained
Drainage canister always below the level of the chest
