Intercoastal drainage

BY SWETA JHA

thoracostomy
Pleural fluid
The pleural space normally
contains 5 to 10 ml of clear
fluid,which lubricates the
apposing surfaces of the
visceral and parietal pleura
during respiratory
movements.
The formation of the fluid
results from hydrostatic and
osmotic pressures.
Definition:-
Drainage of fluid/air/blood/chyle/ from the pleural space
through intercostal space

Indications:-

1)Pneumothorax
2)Hemothorax
3)Empyema
4)Malignant pleural
effusion
5)pleurodesis(sclerotherapy
)
CONTRAINDICATIONS :-
Severe pleural adhesions
Uncorrected/Refractory coagulopathy
Diaphragmatic hernia

PATIENT PREPARATION :-
1)Explain the procedure
2)Informed written consent
3)Mark the site on patient’s chest
4)Monitor o2 saturation and
supplement o2
WORKING PRINCIPLE
Gravity- fluid from a higher level to lower level so always keep
the chest drainage apparatus below the level of person’s chest.

Positive pressure- air or fluid in the chest cavity creates

positive pressure in the pleural space. This is because air moves
from higher pressure to lower pressure created by water seal.

Suction- a pull force of less than atmospheric pressure creates

a sub atmospheric pressure.
 Types of chest drainage

1) SINGLE BOTTLE
WATER SEAL SYSTEM
2) TWO BOTTLE SYSTEM
3) THREE BOTTLE
SYSTEM
Site of insertion :-
5th ICS in mid axillary line
2nd ICS in mid clavicular line

CHEST TUBE INSERTION METHODS:-

1)OPERATIVE TUBE THORACOSTOMY

2)GUIDEWIRE TUBE THORACOSTOMY
3)TROCAR TUBE THORACOSTOMY
4)SINGLE PORT THORASCOPIC TUBE THORACOSTOMY
POSITION OF PATIENT:-
Sitting position: to drain blood , pus fluid
Lateral decubitus position: for pneumothorax
Loculated pathology: USG/CT Guided ICD
 REQUIRED MATERIALS:-

1)STERILE GLOVES , GOWN

2)ANTISEPTIC
SOLUTION(IODINE,CHOLHEXIDI
NE,ALCOHOL)
3)STERILE DRAPES
4)GAUZE SWABS
5)SYRINGES
6)LOCAL ANESTHETIC (1%
Lignocaine)
7)scalpel,Blade
Complications of intercoastal drainage
1)Malposition of the chest tube
2)Lung injury
3)Thoracic duct injury(Chylothorax)
4)Emphysema
5)Phrenic nerve palsy
6)Tube occlusion
7)Hemothorax
8)Injury to abdominal organs
9)Cardiac and great vessel injuries