Describe the anatomy relevant to the insertion of an intercostal catheter
An intercostal catheter drains the intrapleural space.
An ICC should be placed in the safe triangle:
This is bordered:
- Anteriorly by pectoralis major
- Posteriorly by latissimus dorsi
Too far posterior will injure the long thoracic nerve.
- Superiorly by the base of the axilla
- Inferiorly by the 5th intercostal space
Too far inferiorly risks placement in the liver or spleen.
Layers of Dissection
- Subcutaneous tissue
- External intercostal
- Internal and innermost intercostal muscles
Note the neurovascular bundle which sits on the inferior aspect of the ribs, therefore aim to place the ICC at the bottom of the intercostal space - "above the rib below".
- Parietal pleura