Intercostal drainage.pptx

INTERCOSTAL DRAINAGE

1. Intercostal Drainage System Shilpasree Saha Assistant Professor, NIHS

2. Chest drains, also referred to as chest tubes, under water sealed drainage (UWSD), thoracic catheter, tube thoracostomy , or intercostal drain. Chest drains provide a method of removing air & fluid substances from the pleural space. In consists of 3 component: gravity assisted drainage, underwater seal and creation of pressure gradient.

3. The idea is to create a one-way mechanism that will let air/fluid out of the pleural space and prevent outside air/fluid from entering into the pleural space. This is accomplished by the use of an underwater seal. The distal end of the drainage tube is submerged in 2cm of H2O. It uses flexible plastic tube which is inserted through the chest wall and into the pleural space between the 5th and 6th intercostal space in the mid- axillary line, venting the space which allows air back out. 

4. Principles of underwater seal drainage The underwater seal prevents air to re-enter the pleural space. Usually, the distal end of the drain tube is submerged 2cm under the surface level of the water in the drainage (or collection) chamber. This creates a hydrostatic resistance of +2cmH20 in the drainage chamber. Normal intrapleural pressure is negative. However , if air or fluid enters the pleural space, intrapleural pressure becomes positive. Air is eliminated from the pleural space into the drainage chamber when intrapleural pressure is greater than + 2cmH20. Thus , air moves from a higher to lower pressure along a pressure gradient. The drainage chamber has a vent to allow air to escape the chamber, and not build up within the chamber. Fluids will drain by gravity into the drainage chamber, and will not spill back into the pleural space if the bottle is always kept below the level of the patient's chest.

5. Types One bottle UWSD system Two bottle UWSD system Three bottle UWSD system All in one disposable system are also used in which one chamber collect fluid, one chamber will have under water seal to allow air to escape from chest, third chamber is used to control suction .

6. Implications for physiotherapy Important expects of examination: Swinging Bubbling Drainage Suction

7. Swinging Fluid in tube or water sealed chamber should move up and down with respiration. 5 cm of swinging is usual in UWSD and reflects change in pleural pressure Quite breathing causes small swing Coughing or increased respiratory effort causes large swing No swing represents occluded , obstructed, compressed, kinked or detached tubing from pleural space

8. Bubbling Presence of bubbling in underwater seal chamber indicates air leak from pleural space Bubbling on coughing- mild air leakage Bubbling on expiration- moderate air leakage Bubbling through out inspiration and expiration- severe air leakage Bubbling in suction chamber indicates suction is applied correctly

9. Drainage When drainage is reduced to 100 ml over 24 hours, the tube is usually removed. Large amount of blood drain over short period indicates hemorrhage Large amount of haemoserous drainage indicates hypovolaemia , hypotension, low Hb Drainage more than 100 ml per hour needs emergency medical attention

10. Suction When wall suction is applied, it should result in gentle bubbling only in suction chamber only. No bubbling indicates insufficient suction pressure. Vigorous bubbling does not mean increase suction , rather it will evaporate.

11. Persistent air leaks Air leaks fail to resolve before an expected length of time Common complication of patients with emphysema undergoing thoracic surgery and causes longer hospital stay.

12. If tubing become disconnected , it should be clamped by hand close to patient