Intercostal catheter

Dr Owen Kang and Dr Craig Hacking et al.

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 1:

  • 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 orientated slightly superior to the border of the inferior rib to minimise the risk of damaging the neurovascular bundle
  • sterile preparation and drape
  • local anaesthetic 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 haemothorax or fluid drainage
  • drain size
    • 10-14 Fr
    • smaller bore drains are recommended to minimise discomfort
    • larger bore drains are recommended for draining haemothoraces
  • 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

Chest x-ray
Share article

Article information

rID: 59341
System: Chest
Synonyms or Alternate Spellings:
  • ICC
  • pleuracath
  • chest tube
  • pleural catheter
  • ICCs
  • pleural catheters
  • chest tubes
  • pleurocath
  • pneumocath
  • intercostal drain

Support Radiopaedia and see fewer ads

Cases and figures

  • Drag
    Case 1: correct left ICC but persistent PTX
    Drag here to reorder.
  • Drag
    Case 2: malpositioned ICC
    Drag here to reorder.
  • Drag
    Malplaced Chest T...
    Case 3: misplaced chest tube
    Drag here to reorder.
  • Drag
    Case 4: pneumocath in pulmonary artery and left atrium
    Drag here to reorder.
  • Drag
    Case 5: kinked ICC
    Drag here to reorder.
  • Updating… Please wait.
    Loadinganimation

    Alert accept

    Error Unable to process the form. Check for errors and try again.

    Alert accept Thank you for updating your details.