Intercostal Catheter Insertion Bookmark ShareIntercostal 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. Pleural Fluid Analysis Guide***IndicationsPneumothorax, symptomatic effusion, empyema, access for pleurodesisContraindicationsCoagulopathy, infection over insertion siteEquipment & PreparationCap and maskSterile GlovesSterile GownSterile FieldIncluding plenty of gauzeDecontaminantChlorhexidine or povidone-iodineFenestrated Drape5-10mL SyringeFor local anaestheticDrawing Up NeedleLocal Anaesthetic NeedleLocal Anaesthetic10-20mL of 1% lignocaineScalpelForcepsFor blunt dissectionChest DrainUsually 32 - 36 FrDrainage SystemTubing and underwater drainage systemSuture KitSuture material, scissors, forcepsSterile DressingSpecimen ContainersIf draining a pleural effusionExit StrategySharps disposal bin close byInsertionExplain the procedure and ask for patient's consentPositioningPatient supine, arm up above shoulderPlace patient on monitoringIdentify the SiteIntercostal space - safe triangle (pneumothorax) or using ultrasound (effusion)Mark the Insertion SitePrepare Sterile FieldOpen all required sterile equipment onto fieldScrub then don sterile gown and glovesPrepare the SiteDecontaminate a large area with chlorhexidine or iodineApply the fenestrated drapePrepare EquipmentPlace everything in the order it will be usedClamp the proximal and distal ends of the chest drainInject Local AnaestheticCreate a small wheal over the site then inject through the whole insertion tract and into the pleural cavityMake an IncisionUsing the scalpel, make a 2cm incision over the top of the lower rib to avoid nerve / vessel damageBlunt DissectionUsing the forcepsPuncture the PleuraUsing the forcepsInsert a Finger into the Pleura360 degree sweeping motionFeeling for adhesions and lung consistencyInsert the Chest DrainAiming superiorly and posteriorly, ensuring that all side holes on the drain are inside the pleural spaceSuture the Drain in PlaceApply DressingAttach Drain to TubingConfirm Catheter PositionUsing chest x-rayDocumentComplicationsIncorrect PlacementSubcutaneous, extrapleuralBlockageClot, kinking of tubeHaemothoraxDue to haemorrhage from an intercostal vesselDamage to Surrounding StructuresNerves, lung, liver, spleenInfectionAir LeakOn this page: Equipment & PreparationInsertionComplications