intercostal drain

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.

Indication

The indications are wide and can include :

• pneumothorax
• chest trauma
• pleural effusion
• hemothorax
• chylothorax
• bronchopleural fistula
• post-cardiothoracic surgery
• parapneumonic effusion or empyema

Classification

• ICC
• pleuracath
• pleural pigtail catheter

Site

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

Placement

• 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

Complications

• general complications
  • malpositioning
  • pain
  • pneumothorax/tension pneumothorax
  • infection
  • device failure/malfunction
• complications arising from damage to local structures
  • heart and great vessels
  • lungs and tracheobronchial tree
  • esophagus and stomach
  • upper abdominal organs especially the liver and spleen
  • intercostal nerves and vessels

Siehe auch:

• Monaldi-Drainage
• Bülau-Drainage
• Fehllage Thoraxdrainage
• PleurX Kathetersystem

und weiter:

• Weichteilemphysem
• Drainage