Intercostal catheter

The intercostal catheter (ICC or chest tube) is a tube inserted into the pleural space to drain gas or fluid. It is mainly inserted to treat pneumothorax.


The indications are wide and can include :


  • ICC
  • pleuracath
  • pleural pigtail catheter


ICCs are best placed in the triangle of safety, especially when put in urgently.


  • consent
  • patient position
    • preferred: sitting at a 30-45° incline with the arm on side of the procedure abducted
    • alternative: sitting upright and supported onto a table anteriorly or lateral decubitus
  • identify triangle of safety, insertions are preferably oriented slightly superior to the border of the inferior rib to minimize the risk of damaging the neurovascular bundle
  • sterile preparation and drape
  • local anesthetic infiltration down to the level of parietal pleura
  • 1-2 cm incision parallel to the rib
  • blunt dissection using index finger or blunt forceps and breech parietal pleura: will be accompanied by a release of blood, fluid or air
  • dilate insertion site with index finger
  • insert drain with forceps directed towards the lung apex for pneumothorax or basally for hemothorax or fluid drainage
  • drain size
    • 10-14 Fr
    • smaller bore drains are recommended to minimize discomfort
    • larger bore drains are recommended for draining hemothoraces
  • there should be minimal resistance during drain insertion and an appropriate length should be passed within the pleural cavity
  • suture drain superficially and secure
  • connect the drain to an underwater seal drain system
  • confirmation: chest radiograph post procedure
    • in certain drains, the absence of ‘swinging and bubbling’ in the underwater seal mechanism are concerning signs of dysfunction


Siehe auch:
und weiter: