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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. Intrapleural fibrinolytic therapy with either STK or UK does facilitate the drainage of pleural fluid by breaking the loculations without any significant adverse effects.  The fibrinolytic agent is mixed with saline and introduced in the pleural space through the chest tube daily for 3 to 10 days.  After each instillation, the chest tube is blocked for about 3 hours and then it is opened and connected back to the drainage bag.

 

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 fibrinolysis, fever, local erythema and chest pain have been reported in less than 10% of patients. Major haemorrhage was reported in a single case report after 500,000 IU of STK and dwell time of six hours.   There have been isolated case reports of ventricular fibrillation.    There is no significant activation of systemic fibrinolytic system occurs even when a total dose of 1,500,000 IU given in a dose of 250,000 IU, 12 hourly and no monitoring of coagulation parameters is required.  The overall successful rate is 70%.



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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