Intercostal Catheter Insertion

Including plenty of gauze

Chlorhexidine or povidone-iodine

For local anaesthetic

10-20mL of 1% lignocaine

For blunt dissection

Usually 32 - 36 Fr

Tubing and underwater drainage system

Suture material, scissors, forceps

If draining a pleural effusion

Sharps disposal bin close by

Patient supine, arm up above shoulder

Open all required sterile equipment onto field

Decontaminate a large area with chlorhexidine or iodine

Place everything in the order it will be used

Create a small wheal over the site then inject through the whole insertion tract and into the pleural cavity

Using the scalpel, make a 2cm incision over the top of the lower rib to avoid nerve / vessel damage

Using the forceps

Using the forceps

360 degree sweeping motion

Feeling for adhesions and lung consistency

Aiming superiorly and posteriorly, ensuring that all side holes on the drain are inside the pleural space

Using chest x-ray

Subcutaneous, extrapleural

Due to haemorrhage from an intercostal vessel

Nerves, lung, liver, spleen