Intercostal catheter
Citation, DOI, disclosures and article data
At the time the article was created Craig Hacking had no recorded disclosures.
View Craig Hacking's current disclosuresAt the time the article was last revised Arlene Campos had no financial relationships to ineligible companies to disclose.
View Arlene Campos's current disclosures- Chest tube
- Chest tubes
- Intercostal drain
- Intercostal catheter (ICC)
- Intercostal catheters (ICCs)
Intercostal catheters (ICC), or informally chest tubes, are inserted into the pleural space to drain fluid and/or air. They typically refer to large-bore (10-14 Fr) drains placed under direct vision rather than percutaneous pigtail catheters (6-8 Fr) placed under image guidance.
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Indication
The indications are wide and can include 1:
post-cardiothoracic surgery
Technique
consent
-
patient position
preferred: sitting at a 30-45° incline with the arm on the 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
intercostal nerves and vessels
Quiz questions
References
- 1. Kwiatt M, Tarbox A, Seamon MJ, Swaroop M, Cipolla J, Allen C, Hallenbeck S, Davido HT, Lindsey DE, Doraiswamy VA, Galwankar S, Tulman D, Latchana N, Papadimos TJ, Cook CH, Stawicki SP. Thoracostomy tubes: A comprehensive review of complications and related topics. (2014) International journal of critical illness and injury science. 4 (2): 143-55. doi:10.4103/2229-5151.134182 - Pubmed
- 2. Laws D, Neville E, Duffy J. BTS guidelines for the insertion of a chest drain. (2003) Thorax. 58 Suppl 2: ii53-9. Pubmed
- 3. Chadwick A, Halfyard R, Ali M. Intercostal Chest Drains: Are You Confident Going on the Pull? If Not Use the I-T-U Approach. J Intensive Care Soc. 2015;16(4):312-25. doi:10.1177/1751143715583856 - Pubmed
Incoming Links
- Thoracentesis
- Medical abbreviations and acronyms (I)
- Pleural effusion (summary)
- Axilla
- Chest x-ray: lines and tubes (summary)
- Tension pneumothorax
- Medical devices in the thorax
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- Pulmonary contusion after gunshot wound
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- Traumatic pneumothorax with malpositioned intercostal catheter
- Fractured left pleural catheter
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- Malpositioned chest tube - intra-abdominal
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- Kinked intercostal catheter
- Subcutaneous emphysema
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- Tension pneumothorax
- Right lower lobe collapse
- Misplaced chest tube
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