Intercostal Catheter - Underwater Seal Drain


  • Local anaesthesia is mandatory in awake patients and should be used in sedated patients.

  • Strict aseptic technique

  • 28F catheter inserted into 3-4th intercostal space, mid-axillary line, using blunt dissection as described and recommended in the EMST / ATLS guidelines.

  • The catheter must be guided through the ribs without use of sharp instruments (preferably finger).  Trochar aided insertion techniques are not acceptable.


Drains placed in unsterile environs should be removed as soon as possible.

Drains should remain in-situ until radiological resolution has occurred and there is no further bubbling or drainage of significance (< 150ml / 24 hrs)

In patients at risk (due to previous large air leak, or multiple rib fractures)  who remain on positive pressure ventilation, the drain may be clamped for 4hrs prior to removal as a safety measure, although this is by no means universal practice.

Drains placed electively in theatre are the responsibility of the surgeon.



  • Incorrect placement

  • Pulmonary laceration

  • Pneumothorax

  • Bleeding as a result traumatic drain insertion (intercostal artery, lateral thoracic artery, lung etc)

  • Microbial inoculation


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Page last reviewed: 14 May 2014