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  • drgoelmanoj@yahoo.co.in
Dr. Manoj K Goel
Director & Head
Dept of Pulmonology, Critical Care & Sleep Medicine
Fortis Memorial Research Institute,Gurugram(Delhi & NCR)

Details of procedure :


The site of intercostal tube placement is first localised clinicoradiologically or with the help of USG if required.   Antiseptic dressing and draping are done and local anaethesia is given in  and around the area of ICD placement. A small incision is made in the skin  followed by intercostal muscle separation is done to reach to the pleural space. Through this small hole in the chest, the tube is guided and introduced  into the pleural space. The ICD is connected to a appropriate drainage bag.  Once the lung expands fully based on clinic-radiological evidence, then pleurodesis is attempted. The aim of pleurodesis is to achieve a symphysis between visceral and parietal pleural layers, in order to prevent accumulation of either air or fluid in the pleural space. Its main indications are malignant pleural effusions, recurrent pleural effusion and pneumothorax.  The procedure may require sedation and deep analgesia.  The local anaesthetic agent is passed through the chest tube into the pleural space.  Then the sclerosant agent mixed in saline is introduced through the chest tube which is then clamped.  The chest tube is opened after about 3 hours and connected to the drainage bag.  Initially there may be increase in the drainage of fluid, but usually it reduces in amount. Once the drainage is less than 150 ml, the chest tube is removed.  Sometimes, repeat procedures may be required.  The overall success rate is 70%.

 

Possible risks and complications :

The incidence of major and minor complications associated with ICD are 1.9% and 5.5%, respectively.  The complications include improper placement, tube dislodgement, coughing, shoulder pain,  prolonged air leak, hemorrhage, subcutaneous emphysema, postoperative fever, empyema, wound infection, cardiac arrhythmias, reexpansion pulmonary edema, hypotension,  , diaphragmatic tear and injury to surrounding organs.  There may be need for thoracotomy and additional procedures.  The mortality rate associated with ICD performed is 0.09%. With pleurodesis, fever, local erythema and chest pain have been reported in less than 10% of patients. The failure rate may be up to 30%.  There is a very rare risk of formation of multiloculated pleural effusion which may require thoracotomy or thoracoscopic pleurodesis. The pleurodesis is a palliative procedure in cases of malignant pleural effusion and it may not offer prolongation of life.

Post procedure course: 

 

1) ) Postoperative oxygen supplementation may be required in some patients, particularly those with impaired lung function and those who have been sedated.

2) A chest radiograph is carried out post procedure

3) Patients should observe for  pain, breathlessness, haemoptysis, surgical emphysema and excessive coughing.

 



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