IC tube

Sizes 8, 12, 16, 20, 24, 28, 32, 36 Fr Small ones for air Large for fluid Parts Several holes Radiopaque line Length markings starting from lowest hole Indications Hemothorax Pneumothorax Any pleural collection Rib fractures After thoracotomy (lungs, H or oesophagus) Contraindications None except bleeding diathesis etc

Safe area Post. border of Pec major Mid axillary line 4th ICS Therere no imp structures here Also avoids thick muscles of chest wall Insertion need local anaesthesia Drainage bottle Sterile water or saline Underwater seal (2 cm height) 1-way valve - air dont get into the cavity b/c its under water. Water goes up equal to negative intrapleural P (20 cm H2O) but dont go in b/c it kept down from pt level >20 cm. Trap bottle / 2 bottle system can be used for haemopneumothorax & to keep underwater seal a constant.

Mx after insertion CXR to see its safely inside. Keep pt propped up Analgesia Length marking @ chest wall must be >7 cm. otherwise surgical emphysema can occur. Measure output - >1500 ml or 300 ml/hr for 2 consecutive hrs is an indication for thoracotomy. Monitor vital signs Chest physiothrapy Removal < 50 ml/day for 2 con. days Absence of bubbling for 24 hrs CXR confirms re-expansion of lung Removal do not need analgesia Ask pt to take a deep breath out & remove tube; place a gauze pad on the wound. Keep pt under observation CXR after 2 hrs