Intercostal Drain Insertion
Intercostal Drain Insertion places a chest tube between the ribs into the pleural space under ultrasound guidance — providing continuous drainage of a pneumothorax, haemothorax, empyema, or large pleural effusion and allowing the lung to re-expand safely.
Overview
Key Benefits
Discover the advantages of choosing our intercostal drain insertion services.
Provides continuous drainage of pneumothorax, haemothorax, or empyema not manageable by aspiration
Ultrasound guidance dramatically reduces the risk of organ injury compared to landmark technique
Seldinger small-bore drains are well-tolerated with minimal patient discomfort after insertion
Allows the lung to re-expand progressively under controlled conditions
Continuous drainage manages pleural infections more effectively than repeated aspirations
Clinical Features
The technology, techniques and clinical approach behind our intercostal drain insertion.
Ultrasound marking performed immediately before insertion — not hours earlier — for maximum safety
Blunt dissection entry avoids inadvertent vascular or parenchymal injury during insertion
Seldinger technique eliminates the trocar-related insertion injuries of older methods
Immediate connection to underwater seal with swing confirmation before suturing
Post-insertion chest X-ray confirms drain position and initial drainage result
Preparation Instructions
After Intercostal Drain Insertion, keep the drain patent and the drainage system upright and below the level of the chest at all times — never lift the bottle above the chest or clamp the drain unless specifically instructed. Measure and record drain output hourly initially and report any sudden increase, frank blood, or cessation of drainage to the nursing team immediately. Mobilise gently with assistance to promote lung re-expansion and report any increasing chest pain, breathlessness, or subcutaneous emphysema to the medical team.
The Procedure
Step-by-step guide to what you can expect during your intercostal drain insertion procedure.
Pre-Insertion Ultrasound Marking
Immediately before insertion, real-time ultrasound maps the fluid or air collection, identifies the safe triangle (anterior border of latissimus dorsi, lateral border of pectoralis major, above 5th intercostal space), and marks the optimal insertion site on the skin.
Local Anaesthesia and Skin Incision
Generous local anaesthetic is infiltrated from the skin surface to the pleural membrane over the upper edge of the chosen rib. A small skin incision of 1 to 1.5 cm is made and blunt dissection with curved forceps creates a clean path through the intercostal muscles.
Seldinger Guide Wire Placement
For small-bore Seldinger drains, a needle is advanced into the pleural space confirming position by aspiration of fluid or air. A guide wire is passed through the needle, the needle is removed, and the track is progressively dilated before the drain is advanced over the wire.
Drain Positioning and Confirmation
The drain is advanced to its full insertion depth and immediately connected to the underwater seal drainage system. Fluid drainage or bubbling on expiration confirms correct intrapleural position before the drain is sutured and secured to the chest wall.
Underwater Seal Connection and Swing Assessment
The drainage tubing is connected to the underwater seal bottle and fluid swing (movement with breathing) confirms an unobstructed intrapleural drain. Bubbling on expiration or coughing confirms air drainage from a pneumothorax.
Post-Insertion Chest X-Ray
A chest X-ray confirms drain position, the degree of lung re-expansion or fluid drainage, and excludes any new complications. The nursing team records drain output, documents swing, and monitors for signs of drain blockage or displacement throughout the admission.
What to Expect
Intercostal Drain Insertion is performed under ultrasound guidance with local anaesthesia and takes 20 to 30 minutes using the Seldinger technique. A guide wire is introduced into the pleural space through a needle, the track is dilated, and the drain is passed over the wire into the correct position in the pleural cavity — confirmed by drainage of air or fluid and a post-procedure chest X-ray. The drain is secured with sutures and connected to an underwater seal drainage bottle.
Frequently Asked Questions
Common questions about intercostal drain insertion.
Related Services
Explore other services in our Pulmonology department.
Dilatation Tracheal
Flexible Bronchoscopy
EBUS (Endobronchial Ultrasound)
Ready to Get Started?
Schedule your consultation today and take the first step towards better health.