Simulation - 2 (ICD insertion)

Questions:

1. What are the indications for ICD insertion?

2. Describe the anatomical landmarks for ICD insertion.

3. What complications might occur during and after ICD insertion?

4. What equipment is necessary for performing an ICD insertion?

5. How do you confirm correct placement of an ICD?

Steps to follow:

1. Confirm patient identity and obtain informed consent.

2. Perform hand hygiene and use full aseptic technique.

3. Position the patient appropriately (semi-recumbent or supine with arm elevated).

4. Identify anatomical landmarks (usually the 4th or 5th intercostal space in the mid-axillary line).

5. Clean the insertion site thoroughly with antiseptic solution.

6. Drape the area to maintain sterility.

7. Administer local anaesthetic at the insertion site.

8. Make a small incision parallel to the ribs using a scalpel.

9. Perform blunt dissection to enter the pleural cavity.

10. Insert a finger to confirm entry into the pleural cavity and assess for adhesions.

11. Insert the chest drain aiming posteriorly and superiorly for pneumothorax or inferiorly for hemothorax.

12. Secure the drain with sutures and apply an occlusive sterile dressing.

13. Connect the drain to an underwater seal drainage system.

14. Confirm placement with clinical assessment and chest radiograph.

15. Document everything