Intercostal Drainage Tubes -Indications,methods,uses

ICD
Methods of insertion,uses,Contraindications

1. CHEST TUBES

2. Indications Pneumothorax Haemothorax Empyema Malignant Pleural Effusion

3. Chest Tube Size Trend over last few years to use smaller chest tubes (10-14F) Small bore-easier to insert and there is less chance of pain Small bore- for pleurodesis and treatment of pneumothorax Complicated parapneumonic effusions Large Bore – Haemothorax Barotrauma induced pneumothorax

4. Methods of Chest tube Insertion 1.Tube thoracostomy with guidewire and dilators 2.Tube thoracostomy with trocar 3.Operative tube thoracostomy 4.Single poret thoracoscopy

5. Guidewire Tube Thoracostomy

6. Trocar Tube thoracostomy

7. Operative tube thoracostomy

8. Single port thoracoscopy

9. Pleural Drainage One way (Heimlich valve)

10. Useful in Pneumothorax Not useful in effusions Patient can be send home with flutter valve in place

11. One bottle collection system

12. When pleural pressure becomes positive Pressure in the rigid tube increases and if becomes more than the depth to which the tube is immersed, fluid drains into the bottle. Pleural pressure becomes negative Fluid will be drained from the bottle into rigid straw and no fluid enters the pleural cavity. WATER SEAL

13. Two bottle Collection system

14. Suction and three bottle collection system

15. Sometimes negative pleural pressure is necessary to facilitate expansion of the lung Suction Bottle is used-to prevent high suction pressures. Suction applied –air enters rigid straw Air enters through the rigid straw,if the pressure is more negative than the pressure to which it is submerged

16. Ideal Drainage System Water seal should be easily visualised System should be functional when no suction is applied Volume of collection chamber should be adequate and marking should be easily quantified

17. Evaluation of chest tube daily Bubbling-present or not Is the tube functional Amount and type of drainage from the tube

18. complications 1.Misplacement of chest tube 2.Pleural Infection 3.fall out of chest tube 4.Subcutaneous Emphysema

19. Chest Tube removal Procedure should be explained to the patient Dressing should be removed and suture should be cut Pleural pressure should be positive –during removal Ask the patient to perform valsalva -chest tube is quickly pulled out of chest-wound is covered with gauze Wound should be covered sufficiently CXR and USG should be done.