Insertion technique – step by step approach

Written by Shane Convine on . Posted in Uncategorized

360 VIDEO

Insertion technique of ICC

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Insertion technique - step by step

Click on the arrows on the left and right to view each step for insertion.

Step 1

Prep site with Chlorhexidine.

Don sterile gloves and drape patient.

Identify anatomy and mark site with pen.

Infiltrate with local anaesthetic one ICC space below desired level of insertion – this is the incisional level.

Step 2

Make a 2-3 cm incision parallel to the IC space.

Step 3

Bluntly dissect with Kellys forceps through subcutaneous tissue and intercostal muscles of desired space making sure to stay above rib and avoid neurovascular bundle.

Step 4

Spread Kellys to expose the pleura which may need further perforation with forceps.

Step 5

Use finger to sweep intrathoracic cavity to avoid adhesions.

Step 6

Load chest tube onto Kellys by clamping the tip.

Guide into the pleural cavity and advance into the desired space.

Advance superiorly for pneumothorax, inferiorly for fluid collections.

Aim to advance all drainage holes into the chest depending on patient habitus.

Step 7

Connect the ICC to an underwater seal drain.

Suture to secure the catheter to chest wall across incision.

Apply dressing.

The chest is re-examined to confirm effect.

A chest X-ray is taken to confirm placement & position.

Insertion technique -
step by step

Step 1

  • Prep site with Chlorhexidine
  • Don sterile gloves and drape patient
  • Identify anatomy and mark site with pen
  • Infiltrate with local anaesthetic one ICC space below desired level of insertion – this is the incisional level

Step 2

  • Make a 2-3 cm incision parallel to the IC space

Step 3

  • Bluntly dissect with Kellys forceps through subcutaneous tissue and intercostal muscles of desired space making sure to stay above rib and avoid neurovascular bundle

Step 4

  • Spread Kellys to expose the pleura which may need further perforation with forceps

Step 5

  • Use finger to sweep intrathoracic cavity to avoid adhesions

Step 6

  • Load chest tube onto Kellys by clamping the tip
  • Guide into the pleural cavity and advance into the desired space
  • Advance superiorly for pneumothorax, inferiorly for fluid collections
  • Aim to advance all drainage holes into the chest depending on patient habitus

Step 7

  • Connect the ICC to an underwater seal drain
  • Suture to secure the catheter to chest wall across incision
  • Apply dressing
  • The chest is re-examined to confirm effect.
  • A chest X-ray is taken to confirm placement and position