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    Intercostal Drain

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    vamshidh
    This document provides information on the insertion and management of intercostal drains (ICDs). It discusses the basics, indications for ICD insertion, equipment needed, and procedures for insertion, securing the drain, and setting up drainage systems. Nursing responsibilities include observing the patient, drainage system, and wound site. Pain management and procedures for drain removal and post-removal monitoring are also outlined. The goal of ICD insertion is to drain fluid or air from the pleural space and allow lung re-expansion.

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    © All Rights Reserved
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    Intercostal Drain

    Uploaded by

    vamshidh
    2K views44 pages
    This document provides information on the insertion and management of intercostal drains (ICDs). It discusses the basics, indications for ICD insertion, equipment needed, and procedures for insertion, securing the drain, and setting up drainage systems. Nursing responsibilities include observing the patient, drainage system, and wound site. Pain management and procedures for drain removal and post-removal monitoring are also outlined. The goal of ICD insertion is to drain fluid or air from the pleural space and allow lung re-expansion.

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    Intercostal Drain - Nursing management

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    This document provides information on the insertion and management of intercostal drains (ICDs). It discusses the basics, indications for ICD insertion, equipment needed, and procedures for insertion, securing the drain, and setting up drainage systems. Nursing responsibilities include observing the patient, drainage system, and wound site. Pain management and procedures for drain removal and post-removal monitoring are also outlined. The goal of ICD insertion is to drain fluid or air from the pleural space and allow lung re-expansion.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    2K views44 pages

    Intercostal Drain

    Uploaded by

    vamshidh
    This document provides information on the insertion and management of intercostal drains (ICDs). It discusses the basics, indications for ICD insertion, equipment needed, and procedures for insertion, securing the drain, and setting up drainage systems. Nursing responsibilities include observing the patient, drainage system, and wound site. Pain management and procedures for drain removal and post-removal monitoring are also outlined. The goal of ICD insertion is to drain fluid or air from the pleural space and allow lung re-expansion.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
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    At a glance
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    The key takeaways from the document are the indications, contraindications, equipment, procedure and management of intercostal drain insertion.

    The indications for inserting an intercostal drain include pneumothorax, hemopneumothorax, malignant pleural effusion and recurrent pleural effusions.

    The equipment required for inserting an intercostal drain includes sterile gloves and gown, skin antiseptic solution, sterile drapes, local anaesthetic, scalpel, chest tube, connecting tubing and a closed drainage system.

    INTERCOSTAL DRAIN

    Insertion - Management
    Dr T VAMSHIDHAR
    DNB Cardiothoracic Surgery
    CARE Hospitals
    Basics/Introduction
    Indications for ICD
    Pre-Drainage risk assessment
    Equipment
    Consent & Premedication
    Patient Position
    Insertion of chest tube
    Management
    Removal of ICD
    Basics/Introduction
    ICD = Intercostal Drainage
    Indications for Intercostal Drainage
    Emergency Non-Emergency
    1) Pneumothorax Malignant pleural effusion
    In all mechanically ventilated patients Treatment with sclerosing
    Large, or symptomatic pneumothorax agents or pleurodesis
    Clinically unstable patient (hypotension, Recurrent pleural effusions
    increasing O2 requirements) Complex parapneumonic
    Tension pneumothorax (after needle effusion or empyema
    decompression) Chylothorax
    Pneumothorax secondary to chest trauma Postoperative After
    2) Hemopneumothorax (e.g. post-trauma) Thoracotomy/ Cardiac surgery
    3) Esophageal rupture with gastric leak into
    pleural space
    Contraindications
    Absolute Relative

    Lung Completely adherent Coagulopathies


    to chest wall Multiple pleural adhesions
    Patient Refusal
    Pre-drainage Risk assessment

    Hemorrhage- Coagulopathy

    Pneumothorax vs Bullous disease

    Collapse vs Pleural effusion

    Lung adherence to chest wall


    Equipment
    Sterile gloves and gown Suture (silk)
    Skin antiseptic solution, Chest tube
    Sterile drapes Connecting tubing
    Gauze swabs Closed drainage system (including
    A selection of syringes and needles sterile water if underwater seal
    being used)
    Local anaesthetic, e.g. lignocaine 2%
    Scalpel and blade
    Instrument for blunt dissection (e.g.
    curved clamp)
    Dressing
    Chest tube
    Size according to internal diameter (French unit (Fr))
    Numbers marked indicate distance inserted
    Selection of chest tube
    24F 36F for adults
    16F, 20F, 24F for children
    Smaller size for Pneumothorax
    Bigger size for effusions
    Transudate Vs Exudate
    Consent and Premedication
    Informed Consent
    Pain medication
    Anxiolytics
    Emergency drugs loaded and kept ready
    Pre-Procedure checklist
    Right Patient
    Right Site
    Emergency Preparedness
    Consents
    Premedication
    Vitals Monitoring
    Patient Position
    Lying on bed
    Ipsilateral arm behind head
    Slight head up position
    Exposure of Triangle of safety
    Oxygen mask
    Pulse oximetry
    Chest tube Insertion
    Securing the tube
    Silk Sutures
    Purse string sutures avoided
    Y cut guaze dressing
    Drainage System

    One bottle collection system

    Two bottle collection system

    Three bottle collection system


    One bottle collection system
    Consists of one bottle that serves as both a
    collection container and a water seal.
    Chest tube is connected to a rigid tube
    inserted through a stopper into a sterile
    bottle
    Sterile saline is instilled into the bottle - tip of
    the rigid tube is approximately 2cms below
    the surface of saline solution.
    Stopper, Vent
    One bottle collection system

    ADVANTAGES:
    Easy to carry & works well for uncomplicated pneumothorax

    DISADVANTAGES:
    If large amounts of fluid is draining from patients pleural space level of fluid
    will rise in one bottle system and therefore pressure will have to be higher &
    higher in the rigid straw to allow additional air or fluid to exit from pleural
    space
    If the bottle is inadverently placed above level of the patients chest,fluid can
    flow back into the pleural cavity
    2 bottle collection system

    Preferred when substantial amounts


    of fluid is draining from pleural space
    bottle adjacent to the patient acts as
    a collection bottle for drainage, and
    second bottle provides the water
    seal and the air vent.
    Degree of water seal does not
    increase as the drainage
    accumulates.
    3 bottle collection system

    Controlled amount of suction can be


    applied
    A vent on suction control bottle is
    connected to a vent on the water
    seal bottle.
    Suction is connected to a second
    vent on the suction control bottle.
    Pleur evac
    Chest Radiograph
    Ideally within 15-30 minutes after insertion
    Ensure It is reviewed within 3hours by the Medical Officer.
    Nursing Management
    Observation of patient post insertion
    Observation of drainage system
    Observation of wound site
    Securing the drain
    Positioning of patient
    Milking chest tubes
    Pain management
    Clamping
    Changing drainage bottle
    Patient transportation with ICD in situ
    Flushing the tubes
    Removal of ICD
    Observation of Patient Post- removal of ICD
    Observation of patient after insertion of
    Intercostal drain
    Checklist
    Temperature
    Pulse
    BP
    Respiratory Rate, Saturations
    Patient position, Pain, Shortness of breath
    Subcutaneous Emphysema
    Observation of drainage system
    Record volume and amount of drainage
    Drain intermittently (max 1000ml clamp for 20-60min)
    Re- Expansion pulmonary edema
    Underwater seal kept upright
    Record bubbling/swinging air column
    Check looping/kinking of tubes
    Observation of wound site
    Daily inspection of wound
    Daily change of dressing
    Ensure dressing is dry
    No signs of infection (redness,
    swelling, discharge)
    Securing the drain
    Positioning of patient on bed
    Tubing ideally horizontal on bed, before dropping vertically into
    drainage bottle.
    If tube coiled on the floor, lifted every 15-30min to ensure drainage
    Milking of chest tubes
    Creates negative intrathoracic pressure of -100 to -400cmH2O
    Can entrap lung, bleeding, lung damage
    Generally not recommended
    Pain Management
    Pain causes limited movement, prevent lung expansion delayed
    recovery
    Adequate analgesia
    Clamping chest tubes
    Usually should not be clamped.
    Drain which is continuously bubbling should never be clamped
    Clamping done in certain situations
    Following rapid initial drainage of >1000ml in the first hour
    When changing the drainage bottle
    If the tube becomes accidental disconnected
    While transferring a patient where the tubing does not reach
    Following intra-pleural fibrinolytic instillation
    Changing the drainage bottle
    The chest drain unit should be changed if:
    There is damage to the bottle or tubing
    At least every 48 hours, to minimize the risk of infection
    When drainage level reaches 700ml.

    High fluid levels in the bottle increases resistance to further drainage


    and may impact on the patients respiratory function, as greater effort
    is required by the patient to breathe against an increasing pressure.
    Transporting the patients with chest tubes

    Drainage device kept lower than


    patients chest
    Suction can be discontinued for
    short periods if necessary
    Under supervision of medical
    officer
    ICD Removal
    Criteria
    Absence of an air leak into the chest drain bottle, usually noted
    when the patient exhales forcibly or coughs. In positive pressure
    ventilation this will coincide with the expiratory phase;
    Minimal drains
    no evidence of respiratory compromise or failure;
    no coagulation deficit or increased risk of bleeding;
    radiological evidence of the absence of air or fluid accumulation
    Instruction from medical officer
    The procedure
    Ensure that effective analgesia has been administered,
    Teach inhalation and breath-holding technique to ensure
    cooperation;
    Wash hands and don a protective apron;
    Discontinue any suction;
    Provide patient instructions;
    Remove dressing;
    Perform hand hygiene procedure and apply gloves;
    Cut anchor suture (the suture holding the drain in place)
    Instruct the patient to inhale and hold their breath.
    Remove the drain firmly.
    Ask the patient to breathe normally
    Clean the wound and apply a dressing
    Observation of patient after removal of chest
    drains
    Checklist
    Temperature
    Pulse
    BP
    Respiratory Rate, Saturations
    Patient position, Pain, Shortness of breath
    Subcutaneous Emphysema
    Common Problems encountered Cause - Action
    Chest drain Audit tool
    Thank You

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