Introduction:

Intercostal Drainage is a medical procedure used to manage conditions that involve the
accumulation of fluid or air in the pleural space (the area between the lungs and the chest
wall). These conditions may include pneumothorax (air in the pleural cavity), haemothorax
(blood in the pleural cavity), pleural effusion (fluid accumulation), or empyema (pus in the
pleural space).
Sinapi Drain is a specific type of drainage system that can be used for this
purpose, typically involving a closed drainage system to effectively evacuate fluids or air and
prevent complications such as infection or impaired lung function.

Definition of Intercostal Drainage:

Intercostal drainage (ICD), also known as chest tube drainage, is a medical procedure used to
drain abnormal collections of air, blood, or other fluids from the pleural space (the cavity
surrounding the lungs). It involves inserting a drain through the intercostal space (the gap
between two ribs).

 Purpose: The purpose of intercostal drainage is to relieve pressure on the lungs, improve
oxygenation, and allow for the lungs to expand fully. This is crucial in conditions where fluid
or air accumulates and compresses the lungs, impairing breathing and oxygen intake.

Definition of Sinapi Draiage:

A Sinapi Drain is a type of closed suction drain used for post-surgical and clinical drainage.
This drain works by removing fluids and air and preventing their re accumulation. The drain
consists of a flexible tube that is placed in the pleural space to allow for drainage and suction.

Types of Intercostal drainage:

1. Simple (Open) Drainage
 Description: A simple drainage system that allows fluid or air to drain freely from the
pleural space into an external collection container without the use of suction.
 Uses: Generally used for cases where suction is not required or when managing small
amounts of fluid.
 Features:
o Open-ended tube.
o Passive drainage relies on gravity.
 o Typically used in non-complicated cases like minimal pleural effusion

2. Closed Drainage (Sinapi drain)

 Description: A closed drainage system that uses a suction device to actively remove
air or fluid from the pleural space, providing continuous negative pressure.
 Uses: Commonly used for larger pleural effusions, pneumothorax, or when active
removal of air or fluid is necessary.
 Features:
o A flexible tube with one end inserted into the pleural space.
o The other end is connected to a collection chamber or suction device.
o Suction helps to maintain constant negative pressure and prevents
reaccumulation

Parts of sinapi drain

3. Water-Seal Drainage
 Description: A type of closed drainage that includes a water-seal chamber, which
prevents air from being reintroduced into the pleural space while still allowing
drainage.
 Uses: Frequently used for managing pneumothorax and post-surgical drainage.
 Features:
o A water-seal chamber is used to create a one-way valve.
o Air can escape but cannot flow back into the pleural space.
o The level of water in the chamber indicates the amount of suction or bubbling
caused by air leakage.

4. Heimlich Valve
 Description: A small one-way valve attached to the end of a chest tube, typically used
for pneumothorax.
 Uses: Often used in ambulatory or home care settings, particularly for patients with a
small pneumothorax or after surgery.
 Features:
o One-way valve mechanism prevents air from re-entering the pleural space.
o Lightweight and portable
 o Suction is not required, as it allows for passive drainage.

5. Three-Bottle Drainage Systems

 Description: These are closed drainage systems that involve multiple chambers,
typically consisting of a collection chamber, a water-seal chamber, and sometimes a
suction chamber.
 Uses: Primarily for pneumothorax or pleural effusion, when more complex
management is needed, or to maintain suction and fluid control.
 Features:
o The first bottle is for collection.
o The second bottle (water-seal) prevents air from re-entering the pleural space.
o The third bottle, if present, regulates the level of suction applied to the pleural
cavity.

Indications for Intercostal Drainage

Intercostal drainage with may be necessary in the following situations:
 Pneumothorax: The presence of air in the pleural space, often due to trauma,
infection, or spontaneous rupture of the lung.

 Haemothorax: Blood accumulation in the pleural space, often resulting from trauma,
surgery, or rupture of blood vessels.

 Pleural Effusion: Excess fluid accumulation in the pleural space due to conditions
like heart failure, infection, or malignancy.

 Empyema: Pus accumulation in the pleural cavity due to infection.



 Post-Surgical Care: After thoracic surgery (such as lung surgery), a Sinapi drain may
be used to remove fluids and prevent complications like seromas or fluid buildup.
 Chylothorax : a collection of lymph in the pleural space

 Pyothorax : collection of pus in the pleural space

 Hydrothorax: accumulation of serous fluid in the pleural space
Contraindication:
1. Severe Coagulopathy or Bleeding Disorders (e.g., haemophilia, thrombocytopenia,
anticoagulant therapy).
2. Active Infection at the Insertion Site (e.g., cellulitis or abscess near the chest wall).
3. Extensive Chest Wall Trauma or Multiple Rib Fractures (difficult insertion and
risk of further damage).
4. Pleural Adhesions or Fibrosis (increased risk of perforating vital structures).
5. Small Pneumothorax or Minimal Fluid Accumulation (no significant need for
drainage).
6. Positive Pressure Ventilation in Critically Ill Patients (risk of worsening
pneumothorax or respiratory failure).
7. Allergy or Sensitivity to Drain Materials (e.g., latex or silicone allergies).
8. Acute Lung Injury or Severe Respiratory Failure (risk of worsening respiratory
compromise).
9. Inability to Tolerate the Procedure (due to pain, anxiety, or inability to cooperate).

Warning Signs to Watch post iCD insertion:

 Increasing pain at the insertion site.
 Excessive bleeding or changes in the drainage (e.g., becoming more bloody).
 Increased difficulty breathing or chest pain.
 Fever or chills, which could indicate an infection.
 A change in the nature of the drainage (e.g., no output, suddenly very cloudy or
bloody).

Care and Management of Sinapi Drain in Intercostal Drainage:

 Monitoring Drain Output: Regular monitoring of the amount and type of drainage is
essential. The appearance of the fluid (clear, bloody, or purulent) and the amount
drained can give insights into the patient's condition.
 Suction Maintenance: If the drain is connected to a suction device, it is essential to
ensure the suction is functioning properly. The suction pressure should be maintained
at the prescribed level.
 Positioning of the Drain: The patient should be encouraged to change position
frequently to promote better drainage and prevent the formation of clots or obstruction
within the drain.
 Preventing Infection: The insertion site must be kept clean and dry to avoid
infection. The dressing should be changed regularly, and any signs of infection (e.g.,
increased redness, swelling, or discharge) should be reported immediately.

Advantages of Sinapi Drain:

● Easier for doctors, nurses
● Enhancing patient’s mobility.

Potential Complications of Intercostal Drainage

1. Infection: There is always a risk of infection at the insertion site or in the pleural
space, particularly if the drain is not properly maintained.
2. Blockage of the Drain: The drain can become blocked if blood clots or tissue debris
obstructs it, leading to inadequate drainage.
3. Tension Pneumothorax: If air continues to accumulate in the pleural space despite
drainage, tension pneumothorax may occur, which can be life-threatening and
requires emergency intervention.
4. Displacement of the Drain: The drain may become displaced if not properly secured
or if the patient moves too much, which could cause the fluid or air to reaccumulate in
the pleural space.
5. Bleeding: There is a risk of bleeding during the insertion of the drain, especially if
blood vessels are inadvertently damaged.

Do's and Don'ts of Sinapi Drain Usage

Do's:
1. Do Monitor Drain Output Regularly: Check the output of the drain (fluid or air)
regularly. This helps assess the effectiveness of the drainage and ensures there is no re
accumulation of fluid or air.
2. Do Maintain the Suction at Appropriate Levels: If the Sinapi drain is connected to
suction, monitor and maintain the prescribed suction pressure. Too much suction can
lead to tissue damage, while insufficient suction may not drain the fluid effectively.
3. Do Ensure the Drain is Secured: The drain should be secured in place with sutures
to prevent displacement. This reduces the risk of the drain coming out and
complications arising.
4. Do Check for Blockages: Regularly check the drain for kinks or blockages that could
hinder drainage. This is important to avoid complications such as fluid re
accumulation or infection.
 5. Do Observe for Infection Signs: Monitor the insertion site for signs of infection
(redness, swelling, or discharge). If signs of infection are observed, take appropriate
steps to treat the infection promptly.
6. Do Keep the Insertion Site Clean: Maintain a clean, sterile environment around the
drain insertion site. Change the dressing regularly to reduce the risk of infection.
7. Do Educate the Patient: If the patient is ambulatory, educate them on the importance
of not pulling or tugging on the drain and to notify healthcare providers immediately
if there is any discomfort, sudden pain, or signs of infection.

Don'ts:
1. Don’t Disconnect the Drain for Long Periods: Avoid disconnecting the Sinapi drain
from the suction system for prolonged periods, as this could cause re accumulation of
air or fluid in the pleural space.
2. Don’t Apply Excessive Force During Drain Insertion: Avoid excessive force when
inserting the drain. Forceful insertion can damage surrounding tissues or cause
unnecessary trauma to the lung or blood vessels.
3. Don’t Leave the Drain in Place Longer Than Necessary: The drain should be
removed as soon as it is no longer needed. Prolonged drainage increases the risk of
complications, including infection, and can prolong recovery time.
4. Don’t Allow the Drain to Become Dislodged: Avoid any unnecessary movement or
pressure on the drain, which could cause it to become dislodged or displaced. Ensure
it is secured properly at all times.
5. Don’t Let the Drain Become Blocked: Do not let the drain become obstructed by
blood clots, tissue debris, or kinks in the tubing. Blockages can compromise drainage
effectiveness and worsen the condition.
6. Don’t Use the Drain Without Proper Monitoring: Never leave the patient without
proper monitoring of the drain, especially when it is connected to a suction system.
Regular checks ensure that the drain is functioning properly and prevent
complications.
7. Don’t Ignore Signs of Complications: If the patient shows signs of complications
such as respiratory distress, chest pain, or increased output of blood or pus, do not
ignore these symptoms. Seek immediate medical attention to prevent worsening of the
condition.
8. Don’t Forget to Label and Document the Drain Output: Proper documentation of
the amount and type of drainage is important. This ensures accurate assessment of the
patient's condition and the effectiveness of the drainage procedure.
Nurse's Responsibilities in Managing Sinapi Drain:
1. Care of drain:
 o Verify correct placement and secure the drain.
o Monitor and document the type and amount of drainage.
o Maintain the drainage system and check for blockages or leaks.
o Monitor the patient for signs of complications (e.g., infection, bleeding,
respiratory distress).
o Provide pain relief and manage discomfort around the insertion site.
o Change dressings around the insertion site as needed.
2. Patient Education:
o Teach safe mobility to avoid dislodging the drain.
o Educate on recognizing signs of complications (e.g., infection, chest pain,
difficulty breathing).
o Explain how to do spirometry
o Encourage to frequent change the position
3. Documentation:
o Accurately document the drainage output, colour in intake output chart
o Update the care plan based on ongoing monitoring and changes in the patient’s
condition.
4. Communication with the Healthcare Team:
o Report any complications or changes in the patient’s condition to the physician.
o Collaborate with the healthcare team to determine the appropriate time for drain
removal.

Demonstration
Steps of Handling of ICD drain:
Before the procedure
1. Identification of patient
2. Hand washing
3. Arrange all articles
(pair of clean gloves, scissor, measuring jug, Normal saline 0.9% -2, label)
4. Observe the site of insertion of tube
5. Check for oscillation
6. Observe the characteristics and amount of fluid

Procedure (not needed in case of Sinapi)

 1. Clamp the drain
2. Empty the drain & measure the volume
3. Pour NS 100ml- 2 that is 200ml in water seal bag
4. Unclamped the drain
5. Collect the drain in measuring jug
6. Discard the drain ( drain to be collected in 24hrs everyday and as adviced by
physician)
7. Sample to be collected from sample collection port

Post procedure ( documentation)

1. Write the drain amount in intake output chart
2. Add the drain amount in output while calculating I/O for 24 hrs
3. Advice for spirometry
4. Patient and family education
5. Inform sos

Return Demonstration

Conclusion:
This presentation highlights the importance of Sinapi drainage as a vital procedure for
managing conditions like pneumothorax, pleural effusions, and haemothorax. It outlines the
types, indications, contraindications, and key responsibilities of healthcare providers,
particularly nurses, in ensuring effective use of the drainage system. By following proper
protocols for insertion, maintenance, and monitoring, healthcare professionals can minimize
complications and promote optimal patient outcomes. Nurses play an essential role in patient
education, monitoring, and providing emotional support throughout the drainage process,
ensuring both safety and comfort.

Bibliography:
Smith J, Thomas A. Management of pleural effusions and pneumothorax with
intercostal drainage systems. J Clin Respir Care. 2019;34(2):123-130.
Lee S, Park H, Kim J. A review of post-surgical drainage systems and their
complications. Surg Tech Int. 2020;36:112-118.
Berman L, Cheng W. Nursing responsibilities in managing pleural drains. Nurs Care
Quality. 2017;32(3):221-226.