Intercostal Drain

Question 0

Method of insertion

Answer 0

1. Consent
2. Sterile
3. Pt placed supine
4. Arm above head
5. 4/5th ICS, ant. axillary line
6. Local anesthetic (skin, subcut, chest wall)
7. 2cm incision above rib
8. Blunt dissection down
9. “Pop” pleura
10. Insert finger to feel for adhesions
11. Insert clamped tube to level 15
12. Close incision with mattress stitch
13. Secure with elastoplast
14. Attach to drain
15. Unclamp - check if swinging

Question 1

Indications

Answer 1

• Pneumothorax
• Haemothorax
• Chylothorax
• Symptomatic pleural effusion
• Empyema

Question 2

Prerequisites to remove ICD

Answer 2

• Drains less than 50ml/8hrs, or 150ml/24hrs AND still swinging
• Repeat CXR shows full expansion
• Indication resolution

Question 3

Safe Triangle

Answer 3

• Base - 5th ICS
• Post. border - Lattimus dorsi
• Ant. border - Pectoralis major
• Apex - Axilla

Question 4

Maximum Lignocaine dosage

Answer 4

• With adrenaline: 7mg/kg

- Without adrenaline: 5mg/kg