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What is Intercostal drainage or ICD?
Intercostal drainage, commonly referred to as chest drainage, is a medical procedure used to remove air, fluid, or pus from the pleural space in the thoracic cavity. This technique is essential for treating conditions such as pneumothorax, pleural effusion, hemothorax, and empyema.
Procedure Overview
The intercostal drain insertion involves several key steps:
Preparation: Hand hygiene and donning sterile gloves.
Site Identification: Clean the insertion site, typically within the “safe triangle” (lower border of axilla to the 5th intercostal space) to avoid injury to underlying structures4.
Incision and Insertion:
Make a small incision at the chosen site.
Use a Seldinger technique to insert a dilator over a guide wire into the pleural space.
Pass the chest drain over the wire and remove the wire once in place.
Connection and Securing: Attach the drain to a collection system and secure it with sutures to prevent displacement.
Indications for Intercostal Drainage
Intercostal drainage is indicated in several clinical scenarios:
- Pneumothorax: Unresolved primary pneumothorax greater than 2 cm after aspiration attempts or secondary pneumothorax.
- Pleural Effusion: Unilateral effusion causing breathlessness, bilateral effusions unresponsive to medical management, or empyema.
- Tension Pneumothorax: Following needle decompression.
- Palliation: For symptomatic relief in malignant pleural effusions.
- Facilitation of Procedures: Such as pleurodesis.
Equipment Required
The procedure requires specific equipment, including:
- Sterile ultrasound and sheath (for guided procedures)
- Sterile dressing pack and gloves
- Antiseptic swabs (e.g., chlorhexidine)
- Local anesthetics (e.g., Lidocaine)
- Seldinger chest drain kit
- Chest drain tubing and collection bottle
- Sterile water or saline for flushing.
Post-procedure Care
Following insertion, monitoring is crucial:
Ensure proper drainage function and check for complications such as re-expansion pulmonary edema if large volumes are drained rapidly.
Conduct a chest X-ray to confirm correct placement of the drain.
Provide analgesia as needed and document the procedure thoroughly.
Complications
While intercostal drainage is generally safe, potential complications include:
Malposition of the tube leading to ineffective drainage or injury to surrounding structures (e.g., lungs, heart).
Infection at the insertion site.
Hemorrhage or pneumothorax if not performed correctly.