Intercostal Tube Drainage
Definition
Intercostal tube drainage is a surgical procedure used to drain fluid or air from the pleural space.
Indications for ICD
- Pneumothorax
- Hemothorax
- Hemopneumothorax
- Malignant pleural effusion
- Chylothorax
- Empyema
- Fibrinopneumothorax
- Pulmonary contusion
Steps of Intercostal Tube Drainage
1 → Insertion of local anesthesia 2 → Incision of skin 3 → Blunt dissection of intercostal muscles 4 → Incision of parietal pleura 5 → Introduction of intercostal tube 6 → Fixation of tube 7 → Closure of intercostal muscle incision 8 → Closure of skin
Observation or Performance on Mannequin
- Demonstrate proper positioning of patient
- Demonstrate proper insertion of local anesthesia
- Demonstrate proper incision of skin and intercostal muscles
- Demonstrate proper introduction of intercostal tube
- Demonstrate proper fixation of tube
- Demonstrate proper closure of intercostal muscle incision and skin
Pathology
- Pneumothorax: air in pleural space
- Hemothorax: blood in pleural space
- Hemopneumothorax: both air and blood in pleural space
- Malignant pleural effusion: fluid accumulation in pleural space due to malignancy
- Chylothorax: lymphatic fluid accumulation in pleural space
- Empyema: pus accumulation in pleural space
- Fibrinopneumothorax: fibrin accumulation in pleural space
- Pulmonary contusion: bruise in lung tissue
Types
- Intercostal tube drainage
- Chest tube drainage
- Pleural drainage
Clinical Features
- Shortness of breath
- Chest pain
- Cough
- Fever
- Fatigue
Investigations
- Chest X-ray
- CT scan
- MRI
- Pleural fluid analysis
Complications
- Bleeding
- Infection
- Pneumothorax
- Hemothorax
- Cardiac tamponade
- Air embolism
Management
- Insertion of intercostal tube
- Drainage of fluid or air
- Observation of patient
- Removal of tube when drainage ceases
Treatment
- Surgical repair of lung or pleura
- Antibiotics for infection
- Blood transfusion for bleeding
- Oxygen therapy for respiratory distress
Blood Supply
- Intercostal arteries
- Internal thoracic artery
- Posterior intercostal arteries
Nerve Supply
- Intercostal nerves
- Phrenic nerve
- Thoracic nerves
Clinical Anatomy
- Intercostal muscles
- Parietal pleura
- Visceral pleura
- Lung tissue
Homoeopathic Therapeutic Medicines
- Arnica montana: for trauma and pain
- Belladonna: for inflammation and infection
- Bryonia: for respiratory distress and cough
- Ferrum phosphoricum: for bleeding and fatigue
- Phosphorus: for respiratory distress and fatigue