ICD Management

1. ICD MANAGEMENT
Pubali Kalita
BPT Student

3. WHAT IS ICD(INTERCOASTAL DRAINAGE
TUBE) ?
• An intercostal drain is a flexible plastic tube that is inserted
through the chest wall into the pleural space .
• Also known as chest drainage tube , under water sealed
drainage (UWSD), or intercostal drain .
• Drainage of fluid, blood, air, or pus out of the chest .

5. Insertion sites :
• For air drainage : 2nd/3rd ICS (mid–clavicular line)
• For fluid/blood drainage : 8th/9th ICS

8. • Indications :
1. Pneumothorax
2. Haemothorax
3. Pleural effusion (in massive condition too)
4. Empyema
5. Chylothroax
6. Post-operative conditions (thoracotomy with decortication , oesophageal
surgery , cardiac surgery ) .
• Contraindications :
1. Refractory coagulopathy
2. Diaphragmatic hernia
3. Scarring in the pleural space (adhesions)

9. • PT Role regarding ICD Mx :
- Firstly , the flexible chest tube need to be checked prior to PT
treatment .
- Secondly , check for the fluid level in the collecting chamber .
- Ensure that no kinks should be present .
- Patient shouldn’t be lying on the tube , the tube should be empty of
fluid .
- If there is any blockage (by clots) , the chest tube needs to be
milking(i.e., techniques such as squeezing, kneading, or twisting the
tube to create bursts of suction to move clots) .
- The chest drain must always be kept below the level of the patient’s
chest.
- If the tubing becomes disconnected, it should be clamped by hand
as close to the patient as possible . Care should be taken when a
patient is getting out of bed or moving around the bed .

10. • Care should be taken to avoid generating to create any negative
pressure & therefore the danger of lung tissue damage in
contact with holes in tube .
• If any positive pressure is being used then air leaking should be
monitored if there’s any .
• The chest drain tube maybe quite painful to patient which may
limit the patient from cooperating in the treatment session .
• Patients should be able to move around during the time the
drain is in situ .They should be encouraged to keep the shoulder
of the affected side moving, and discouraged from adopting
protective patterns .

11. • If there’s a suction port attached to the chest drain and
mobilisation need to be done to the patient ,the suction
can be disconnected temporarily , but it is essential to
communicate with the medical and nursing team prior to
doing so .If the patient is unable to be disconnected from
suction, walking within the confines of the tubing or spot
marching can be given to do .
N.B : If more suction is applied , the fluid level in glass tube
or bottle seal chamber should fluctuate with each breath .

12. • If the chest tube to be removed after 1day only , for this patient
chest PT can be given & must ensures that the lung is free of
secrections prior to the tube removal is of utmost priority that
need to be taken .

14. Physiotherapy Treatment Options :
Techniques that are indicated to remove air from pleural space :
1. Mobilisation
2. Deep breathing exercises: (N.B FET & Supported Cough)
# Positive pressure NIV techniques are contraindicated .

15. COMPLICATIONS OF CHEST DRAINS
• Pain
• Haemorrhage
• Blocked drains
• Pleural sepsis
• Subcutaneous emphysema
• Infection at insertion site
• Penetration / lacerations to lungs .