Intercostal Tube

Intercostal Tube

A Intercostal tube (chest tube) is a hollow, flexible tube placed into the chest. It acts as a drain. The intercostal tube is placed between the ribs and into the space between the inner layer and the outer layer of the chest. This is called the pleural space.

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Emergency conditions

  • Pneumothorax
  • In all patients on mechanical ventilation
  • When pneumothorax is large
  • In a clinically unstable patient
  • For tension pneumothorax after needle decompression
  • When pneumothorax is recurrent or persistent
  • Esophageal rupture with gastric leak into pleural space
  • When pneumothorax is secondary to chest trauma
  • When pneumothorax is iatrogenic, if large and clinically significant

Non-Emergency conditions

  • Malignant pleural effusion
  • Treatment with sclerosing agents or pleurodesis
  • Recurrent pleural effusion
  • Parapneumonic effusion or empyema
  • Chylothorax
  • Postoperative care (e.g., after coronary bypass, thoracotomy, or lobectomy)
  • The need for emergent thoracotomy is an absolute contraindication to tube thoracotomy.
  • Coagulopathy
  • Pulmonary bullae
  • Pulmonary, pleural, or thoracic adhesions
  • Skin infection over the chest tube insertion site
  • Loculated pleural effusion or empyema
  • Bleeding and hemothorax due to intercostal artery perforation
  • Perforation of visceral organs (lung, heart, diaphragm, or intraabdominal organs)
  • Perforation of major vascular structures such as the aorta or subclavian vessels
  • Intercostal neuralgia due to trauma of neurovascular bundles
  • Subcutaneous emphysema
  • Reexpansion pulmonary edema
  • Infection of the drainage site, pneumonia, and empyema.
  • There may be technical problems such as intermittent tube blockage from clotted blood, pus, lines for the insertion of a chest drain or debris, or incorrect positioning of the tube, which causes ineffective drainage.
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