Intercostal Catheter Insertion

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

Explain the procedure and ask for patient's consent

Positioning

Patient supine, arm up above shoulder

Place patient on monitoring

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

Incorrect Placement

Subcutaneous, extrapleural

Haemothorax

Due to haemorrhage from an intercostal vessel

Damage to Surrounding Structures

Nerves, lung, liver, spleen

Infection

Air Leak