Chest Drain (Intercostal Catheter) Insertion
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Chest Drain (Intercostal Catheter) Insertion See also: Primary Spontaneous Pneumothorax Needle Aspiration Notes Equipment Analgesia, anaesthesia and sedation Procedure Post-proce dure care Notes Fluid or air that accumulates in the pleural space will reduce lung expansion and lead to respiratory compr omise and hypoxia. Insertion of an intercostal catheter (ICC ) enables drainage of air or fluid from the pleural space, allowing negative intra-thoracic pressures to be re- established leading to lung re-expansion. Indications: Pneumothorax Haemothorax Pleural effusion Contraindications: Need for immediate thoracotomy Complications: Pain Thoracic or abdominal visceral trauma Tension pneumothorax Equipment Special procedures tray Under water sealed drain system (UWSD) use cell saver UWSD for massive haemothorax Intercostal Cathete r (guide sizes only) use smaller size for draining air larger size for draining blood/fluid Newborn 8-12 FG Infant 12-16 FG Child 16-24 FG Adolescent 20-32 FG Spigot connector / tube adaptor - 2 sizes Suction must be available and working Sterile gloves & gown Mask Sterile towels x 2 500ml bottle of sterile water Antiseptic solution 1% lignocaine + 1:100,000 adrenaline 5mL ampoule 5ml/10ml syringe and needle Scalpel blade Suture material - black silk or nylon with needle size 3.0 x 2 Sleek and Tegaderm x 2 Anal gesi a, Anae sthe sia,Sedation Local anaesthetic and intravenous analgesia are mandatory, as ICC placement is a painful procedure. The use of sedation should always be discussed with a senior emergency doctor, as it can potentially worsen the patient's clinical condition.
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Chest Drain (Intercostal Catheter) InsertionSee also: Primary Spontaneous Pneumothorax
Needle Aspiration
NotesEquipmentAnalgesia, anaesthesia and sedationProcedurePost-procedure care
NotesFluid or air that accumulates in the pleural space will reduce lung expansion and lead to respiratory compromise and hypoxia.
Insertion of an intercostal catheter (ICC) enables drainage of air or fluid from the pleural space, allowing negative intra-thoracic pressures to be re-established leading to lung re-expansion.
Indications:
PneumothoraxHaemothoraxPleural effusion
Contraindications:
Need for immediate thoracotomy
Complications:
PainThoracic or abdominal visceral traumaTension pneumothorax
EquipmentSpecial procedures trayUnder water sealed drain system (UWSD)
use cell saver UWSD for massive haemothoraxIntercostal Catheter (guide sizes only)
use smaller size for draining airlarger size for draining blood/fluid
Newborn 8-12 FGInfant 12-16 FGChild 16-24 FGAdolescent 20-32 FG
Spigot connector / tube adaptor - 2 sizesSuction must be available and workingSterile gloves & gownMaskSterile towels x 2500ml bottle of sterile waterAntiseptic solution1% lignocaine + 1:100,000 adrenaline 5mL ampoule5ml/10ml syringe and needleScalpel bladeSuture material - black silk or nylon with needle size 3.0 x 2Sleek and Tegaderm x 2
Analgesia, Anaesthesia, SedationLocal anaesthetic and intravenous analgesia are mandatory, as ICC placement is a painful procedure. The use of sedation should always be discussedwith a senior emergency doctor, as it can potentially worsen the patient's clinical condition.
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ProcedureEstablish patient on continuous cardiac monitoring and pulse oximetry
Place conscious patient in a sitting position at 45 degrees with arm of same side placed above headPalpate the fourth or fifth intercostal space just anterior to the mid-axillary lineSurgically prepare the areaEnsure local anaesthetic is infiltrated from subcutaneous tissue down to pleura.Select the appropriate size I.C.C. and remove stylet .
Incise the skin parallel to the upper border of the rib below the chosen intercostal space. Incise down to the fascia."Blunt dissect" (using an artery forcep) down to the pleura, enter the pleural space, and then widen the hole by opening the forceps.Sweep the pleural space with a gloved finger to widen the hole and push the lung away from the hole (only possible in older children, beware ofrib fractures in injured child).Hold the tip of the catheter with a curved artery clamp and advance it into the pleural space, directing the catheter posteriorly and superiorly.Advance so that all apertures of the tube are in the chest and not visibleAttach the tube to UWSD below the patient's chest levelAnchor the drain and suture the wound. Tape in place with tegaderm sandwich and anchor the tube to the patient's side.Connect to the UWSD.Watch for "swinging" of water in tube connection.
Post-Procedure CareReassess ABCs and ensure ICC is functioning
Reassess need for analgesia.In children following the removal of the tube coverage with a large tegaderm is sufficient for closure rather than a formal purse string suture.
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Last Updated 06-Sep-2006. Authorisedby: Simon Young/Mike South . Enquiries: Mike South . © 2006-2009 The Royal Children's Hospital, Melbourne.All rights reserved.Warning: This website and the information it contains is not intended as a substitute for professional consultation with a qualified practitioner.
