Download INTERCOSTAL DRAINAGE AND

INTERCOSTAL DRAINAGE AND
ITS MANAGEMENT
DR.V.CHITRALEKA . M.S.M.Ch
DEPARTMENT OF CARDIOTHORACIC SURGERY
S.R.M. MEDICAL COLLEGE HOSPITAL ANATOMY OF THORAX
ICD – INTERCOSTAL DRAINAGE
y DEFINITION : THORACOSTOMY
y Drainage of fluid / air / blood /chyle from the pleural space through intercostal space
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y INDICATIONS
y CONTRAINDICATIONS
y PNEUMOTHORAX y DIAPHRAGMATIC y HEMOTHORAX
y REFRACTORY y EMPYEMA
y SEVERE PLEURAL HERNIA
COAGULOPATHY
ADHESIONS
y CHYLOTHORAX
y FLAIL SEGMENT REQUIRING VENTILATOR
DIAGNOSTIC AIDS
y X‐RAY CHEST
y CT SCAN CHEST
y FAST ULTRASOUNDE y CLINICAL SUSPICION INCRITICAL CASES
PURPOSE y
Diagnostic y
Therapeutic
TECHNIQUE OF INSERTION
Mostly EMERGENT ‐Placement of tube is vital to avoid complications
TECHNIQUE
y PAINFUL PROCEDURE
y Usually done under local anesthesia
y May need additional pain killers
PREPROCEDURE PLAN
y OBTAIN INFORMED CONSENT
y INFORM THE PATIENT THE POSSIBILITY OF MAJOR COMPLICATIONS
y EXPLAIN THE MAJOR STEPS OF PROCEDURE AND NEED FOR REPEATED XRAYS
MATERIALS NEEDED
y Chest tube with / without trocar
y ICD TRAY – No 11 / 23 Blade with handle, Large Kellys clamps, needle driver, Scissors
y 2‐0 Ethilon / mersilk y Mask, gloves & gown SITE OF INSERTION
y SAFE ZONE
y Lateral border of Pectoralis major
y Horizobtal line inferior to Axilla
y Anterior border of Lattisimus Dorsi
y Horizontal line superior to nipple
y 5TH INTERCOSTAL SPACE
POSITION
INCISION
PROCEDURE ‐ Contd
y Local area preparation y Sterile drapings
y Incision along the upper border of the rib
y Curved Clamp is used to develop the tract & then with the finger
y Finger inserted into the pleural space for exploration
y Large bore chest tube (32‐36 F ) is passed along the tract into yhe pleural cavity
y Tube is connected to underwater seal & secured with sutures
y Check xray to be taken INCISION ‐ CONTD
INCISION ‐ CONTD
CHEST TUBE DRAINS
y Available from size 12 F – 36 F
y Large size tube are preferred in case of effusions
y Can be placed with / without trocar
CHEST DRAIN
UNDERWATER SEAL DRAIN
y To Allow air to escape through drain BUT NOT TO REENTER
y Always be kept below the level of the patient
y NEVER CLAMP – avoid TENSION PNEUMOTHORAX
y Moderate suction – (‐ 20 cm ) especially in air leak
UNDERWATER SEAL DRAIN
UNDERWATER SEAL DRAIN
Care of Intercostal tubes y DRESSINGS: y CHEST XRAY
y OBSERVATIONS: y Report immediately chest drainage of >200mls of blood in a 1 to 2 hour time frame. y *Continuous Sa 02 monitoring. Keep 02 Sa > 96%. y *Observe the swings of fluid in the chest tube bottle. ICD CARE
y NEVER CLAMP AN INTERCOSTAL TUBE: WHY?? y BECAUSE TENSION PNEUMOTHORAX IF FORGET TO REMOVE CLAMP
ASSESS AND REPORT ANY OF THE FOLLOWING
y Sudden drop of Sa 02 < 90% y *increased restlessness and anxiety of the patient. y *cessation of swing, or swing < 2cm. y *absent or decreased breath sounds on the side of the pneumothorax. y *tympany or hollow sound on chest percussion. Contents of the chest bottle
y sterile solution that is not toxic to the lungs y Water / saline / dextrose INDICATION FOR REMOVAL
y No Drain
y No Air leak
REMOVAL OF ICD
y Explain procedure to patient and place in a position of comfort y Remove sterile dressing. Cut suture y Ask patient to take a deep breath and hold y then remove the tube and place a sterile piece of gauze and airtight over the site. ACUTE COMPLICATIONS
y Hemothorax
y Tube placed y Lung laceration
subcutaneously
y Tube placed too far
y Injury to Diaphragm
y Tube falls out
y Stomach / Colon injury y Reexpansion pulmonary in unrecognised Diaphragmatic Hernia
edema
LATE COMPLICATIONS
y Blockage of tube ( clot / lung )
y Retained hemothorax y Empyema
y Pneumo thorax after tube removal
y Infection CONCLUSION
y Emergency life saving procedure
y Maintaining the patency is critical to avoid complicati0ns
y Subcutaneous emphysema clog /insufficient negative pressure