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Intercostal Catheter Insertion
Intercostal catheters (chest tubes) are used either for the diagnostic purpose of identifying the cause of a pleural effusion, or therapeutically in order to drain a pneumothorax or pleural effusion.
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Equipment & Preparation
- Cap and mask
Sterile Gloves
Sterile Gown
Sterile Field
Including plenty of gauze
Decontaminant
Chlorhexidine or povidone-iodine
Fenestrated Drape
5-10mL Syringe
For local anaesthetic
Drawing Up Needle
Local Anaesthetic Needle
Local Anaesthetic
10-20mL of 1% lignocaine
Scalpel
Forceps
For blunt dissection
Chest Drain
Usually 32 - 36 Fr
Drainage System
Tubing and underwater drainage system
Suture Kit
Suture material, scissors, forceps
Sterile Dressing
Specimen Containers
If draining a pleural effusion
Exit Strategy
Sharps disposal bin close by
Insertion
- Explain the procedure and ask for patient's consent
Positioning
Patient supine, arm up above shoulder
- Place patient on monitoring
Identify the Site
Intercostal space - safe triangle (pneumothorax) or using ultrasound (effusion)
Mark the Insertion Site
Prepare Sterile Field
Open all required sterile equipment onto field
- Scrub then don sterile gown and gloves
Prepare the Site
Decontaminate a large area with chlorhexidine or iodine
- Apply the fenestrated drape
Prepare Equipment
Place everything in the order it will be used
- Clamp the proximal and distal ends of the chest drain
Inject Local Anaesthetic
Create a small wheal over the site then inject through the whole insertion tract and into the pleural cavity
Make an Incision
Using the scalpel, make a 2cm incision over the top of the lower rib to avoid nerve / vessel damage
Blunt Dissection
Using the forceps
Puncture the Pleura
Using the forceps
Insert a Finger into the Pleura
360 degree sweeping motion
Feeling for adhesions and lung consistency
Insert the Chest Drain
Aiming superiorly and posteriorly, ensuring that all side holes on the drain are inside the pleural space
Suture the Drain in Place
Apply Dressing
Attach Drain to Tubing
Confirm Catheter Position
Using chest x-ray
Document
Complications
Read More...
Bailey RC. Complications of tube thoracostomy in trauma. Journal of accident & emergency medicine. 2000 Mar 1;17(2):111-4.MacDuff A, Arnold A, Harvey J. Management of spontaneous pneumothorax: British Thoracic Society pleural disease guideline 2010. Thorax. 2010 Aug 1;65(Suppl 2):ii18-31.Millikan JS, Moore EE, Steiner E, Aragon GE, Van Way CW. Complications of tube thoracostomy for acute trauma. The American Journal of Surgery. 1980 Dec 1;140(6):738-41.Tang A, Velissaris TJ, Weeden DF. An evidence?based approach to drainage of the pleural cavity: evaluation of best practice. Journal of evaluation in clinical practice. 2002 Aug 1;8(3):333-40.