Definition, indication, parts, types, procedure, NR

1. Intercostal Tube Insertion
Dr. Uttpal Desai
( Senior Surgeon)
Mr. Mahesh Chand
( Nursing Tutor)

2. Definition
Inter costal water seal
drainage system is
insertion of tubes into
the pleural cavity with
attached drainage
system so as to remove
air, blood or fluid from
the pleural cavity.

3. Tube and Bag
Size Varies from 6 to 40 Fr.

4. Purpose
• To remove air, blood or fluid
• It promotes re-expansion of lung.

5. Indication
• Pneumothorax
• Heamothorax
• Thoracotomy
• Chest surgery
• Chest trauma

6. Principles Related To Close Chest
Drainage System
• Gravity- fluid from a higher level to lower level.
Therefore, always keep the chest drainage
apparatus below the level of person’s chest.
• Positive pressure – air or fluid in the chest cavity
creates positive pressure in the pleural space.
This is because air moves from higher pressure to
lower pressure created by water seal.
• Suction – A pull force of less than atmospheric
pressure creates a sub atmospheric pressure.

7. Types of chest drainage
• Single bottle water seal system
• Two bottle system
• Three bottle system

8. Preparation of Patient
• Explain the procedure.
• Keep the patient in fowler’s position
• Reassure the patient and allay all his/her
doubts and fears

9. Preparation of Articles
Sterile tray containing:
• Sterile chest tube of an appropriate size
• Sterile drape
• Gloves mask, cap, gown
• Syringe and needle for local anesthesia
• Lignocaine 2%
• Cleaning articles Betadine Gauze
• Adhesive plaster, tincture benzoin
• A mackintosh with towel
• screen

10. Procedure
Explain the procedure (Reduce anxiety)
Assist the surgeon with the insertion of
chest tube
Connect the chest tube to water seal
drainage

11. After care of patient and articles
• Stay with the patient till he/ she is at ease.
• Keep the patient comfortable.
• Observe vital signs and drainage.
• Check the chest wall wound is sealed well.
• Take all the used articles to the utility room.

12. Nursing responsibility
• Observe the Chest tube dressing
• Observe the Tubing for kink, clots for maintains a
patent, freely draining system.
• Chest drainage should be upright and below the
level of tube insertion.
• Observe for Water seal for fluctuations with
patient’s inspiration and exertion.
• Fluid rise on inspiration and falls with expiration,
indicating proper functioning of the system.

13. • Observe for bubbling in water seal bottle/ chamber.
• Ensure drainage tube in water seal 2.5 cm below
the water level.
• Ensure that 2 tubing clamps are always at the
patient bed side.
• Maintain a high fowlers position .
• Maintain all connection between chest and
drainage tubes intact and taped.
• Wash hand every time whenever handle the tube.

14. Precaution to be taken while
replacing the chest drainage bottles
• Assemble the bottle with tight stopper and
tubes and check for functioning.
• Double clamp the chest catheters close to the
patient’s chest to prevent entry of air into
pleural cavity.
• Clamps are applied at the end of full inspiration
to prevent the air being sucked into pleural
space .

15. • Disconnect the bottle is placed to be replaced
along with the drainage tubing and attach
new set.
• Unclamp the patient chest catheter and make
sure that the system is functioning properly
before leaving the patient.
• Watch the patient vital signs for few minutes
to see any changes in general condition .

16. Bibliography
• Annamma Jacob, Rekha R, Jadhav Sonali Trachand
“clinical nursing procedures: the art of nursing practice,
second edition, Jaypee publication: 2011, pg.no 436-
437
• Sr. Nancy, “principles and practice of nursing”, Senior
nursing procedures, volume two, N.R publishing house:
2005 Pg. no 201-205
• Trained nurses association of India, “fundamentals of
nursing a procedure manual”: first edition-
2005,Published by secretary-general Pg. no- 513-516
• Brunner and Suddarth’s textbook of medical surgical
nursing, eleventh edition, Published by Wolters Kluwer
Pg. no 816