Needle thoracostomy: Difference between revisions
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==Indications== | ==Indications== | ||
* Suspected tension pneumothorax needing immediate decompression | *Suspected [[tension pneumothorax]] needing immediate decompression | ||
* Hemodynamically unstable | **Blunt [[chest trauma]], [[shortness of breath]], asymmetric lung sounds, deviated trachea, crepitance, [[hypotension]] | ||
*[[shock|Hemodynamically unstable]] | |||
==Equipment Needed== | ==Equipment Needed== | ||
* 14 to 16 gauge IV needle/catheter | *5cm 14 to 16 gauge IV needle/catheter | ||
* 5 or 10mL syringe | *5 or 10mL syringe | ||
==Procedure== | ==Procedure== | ||
* Insert 14 to 16 gauge IV needle catheter attached to syringe along superior margin of 2nd or 3rd rib in midclavicular line | *Insert 5 cm 14 to 16 gauge IV needle catheter attached to syringe along superior margin of 2nd or 3rd rib in midclavicular line | ||
* Advance needle until air is aspirated to syringe | **Evidence suggests lowest failure rate of needle decompression is at the 4th/5th rib space along the anterior axillary line <ref>Laan DV et al. Chest Wall Thickness and Decompression Failure: A systematic Review and Meta-Analysis Coparing Anatomic Locations in Needle Thoracostomy. Injury 2015 [Epub Ahead of Print]. PMID: 26724173</ref> | ||
* Withdraw needle | *Advance needle until air is aspirated to syringe | ||
* Leave angiocatheter open to air | *Withdraw needle | ||
* Immediate rush of air out of chest = tension pneumothorax | *Leave angiocatheter open to air | ||
* Follow immediately with standard thoracostomy tube | *Immediate rush of air out of chest = tension pneumothorax | ||
*Follow immediately with standard thoracostomy tube | |||
==Complications== | ==Complications== | ||
* Kinking of catheter | *Kinking of catheter | ||
* Dislodgement | *Dislodgement | ||
* Recurrence of tension pneumothorax | *Recurrence of [[tension pneumothorax]] | ||
* Lung laceration | *[[Lung laceration]] | ||
* Air embolism | *[[Air embolism]] | ||
==See Also== | ==See Also== | ||
*[[ | *[[Tension pneumothorax]] | ||
*[[ | *[[Finger Thoracostomy]] | ||
==External Links== | ==External Links== | ||
==References== | |||
*Roberts, 179 | |||
*Wolfson, 82, 129 | |||
<references/> | <references/> | ||
[[Category:Procedures]] | [[Category:Procedures]] | ||
[[Category:Critical Care]] | |||
[[Category:Pulmonary]] | |||
Latest revision as of 22:33, 25 November 2020
Indications
- Suspected tension pneumothorax needing immediate decompression
- Blunt chest trauma, shortness of breath, asymmetric lung sounds, deviated trachea, crepitance, hypotension
- Hemodynamically unstable
Equipment Needed
- 5cm 14 to 16 gauge IV needle/catheter
- 5 or 10mL syringe
Procedure
- Insert 5 cm 14 to 16 gauge IV needle catheter attached to syringe along superior margin of 2nd or 3rd rib in midclavicular line
- Evidence suggests lowest failure rate of needle decompression is at the 4th/5th rib space along the anterior axillary line [1]
- Advance needle until air is aspirated to syringe
- Withdraw needle
- Leave angiocatheter open to air
- Immediate rush of air out of chest = tension pneumothorax
- Follow immediately with standard thoracostomy tube
Complications
- Kinking of catheter
- Dislodgement
- Recurrence of tension pneumothorax
- Lung laceration
- Air embolism
See Also
External Links
References
- Roberts, 179
- Wolfson, 82, 129
- ↑ Laan DV et al. Chest Wall Thickness and Decompression Failure: A systematic Review and Meta-Analysis Coparing Anatomic Locations in Needle Thoracostomy. Injury 2015 [Epub Ahead of Print]. PMID: 26724173