Intercostal catheter insertion

Overview

An intercostal catheter is a tube used to drain air, blood or other fluid by insertion into the
pleural space. In trauma this is commonly used to manage either pneumothorax or
haemothorax or a combination of both.

Contraindications in the acute trauma patient are relatively limited, due to the emergent
requirement to improve either haemodynamics and/or oxygenation/ventilation in the setting
of tension or significant haemo/pneumothorax. However, a known history of previous
pleurodesis and local infection may result in the clinician using alternate insertion techniques
or location.

An intercostal catheter should be placed in the triangle of safety to avoid the neurovascular
bundle, reduce risk of injury to the mammary artery or breast tissue and avoid inadvertent
intraperitoneal insertion.

The size of pneumothorax that requires treatment may vary depending on both clinical
situation and patient factors. A patient with signs of tension clinically (tachycardia,
hypotension and hypoxia) should be managed with surgical thoracostomy followed by the
insertion of an intercoastal catheter connected to a chest drainage system.. In the stable
patient, who does not require positive pressure ventilation or transfer in a non-pressurised
aircraft, a conservative approach may be taken.

The supine CXR can be challenging to accurately measure the size of the pneumothorax,
with CT measurement of <35mm measured between the parietal and visceral
pleura/mediastinum shown to be safe for an observational approach. (Eddine, Boyle, Dodgion et al. 2019)

Longer term complications of intercostal catheter insertion include empyema, pain, bleeding
and damage to underlying structures.

Description

This resource kit provides healthcare workers with knowledge of the technical skills required for the insertion of an intercostal catheter (ICC) for the management of haemothorax or pneumothorax following trauma.

Learning objectives

• Demonstrate knowledge of the indications and contraindications for ICC insertion.
• Identify the anatomical landmarks for safe insertion.
• Identify the essential equipment required for set up.
• Perform the insertion of an ICC utilising the correct procedure.
• Demonstrate knowledge of post-procedure cares.

Downloads

Further reading

Videos