Finger thoracostomy: Difference between revisions
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==Overview== | ==Overview== | ||
The '''finger thoracostomy''' is an alternative to [[needle thoracostomy]] for emergent decompression of a suspected [[tension pneumothorax]] | *The '''finger thoracostomy''' is an alternative to [[needle thoracostomy]] for emergent decompression of a suspected [[tension pneumothorax]] | ||
*Numerous studies suggest that needle thoracostomy inconsistently accesses the pleural space | |||
*This alternative procedure allows for tactile (+/- visual) feedback that the pleural space has been accessed | |||
*Will cause an open pneumothorax. | |||
*Has ''not'' been studied head-to-head against needle thoracostomy | |||
**Thus, any advantages/disadvantages are currently based on expert opinion rather than strong evidence | |||
==Indications== | ==Indications== | ||
* | *Clinical [[tension pneumothorax]] | ||
==Contraindications== | ==Contraindications== | ||
* | *Local trauma: possibility of sharp bone fragment/foreign body | ||
==Equipment Needed== | ==Equipment Needed== | ||
*sterile gloves | *sterile gloves | ||
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*betadine | *betadine | ||
*lidocaine, syringe, needle | *lidocaine, syringe, needle | ||
==Procedure== | ==Procedure== | ||
#Recognize possible tension physiology. | #Recognize possible tension physiology. | ||
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[[Category:Procedures]] | [[Category:Procedures]] | ||
[[Category:Critical Care]] |
Revision as of 16:16, 9 October 2019
Overview
- The finger thoracostomy is an alternative to needle thoracostomy for emergent decompression of a suspected tension pneumothorax
- Numerous studies suggest that needle thoracostomy inconsistently accesses the pleural space
- This alternative procedure allows for tactile (+/- visual) feedback that the pleural space has been accessed
- Will cause an open pneumothorax.
- Has not been studied head-to-head against needle thoracostomy
- Thus, any advantages/disadvantages are currently based on expert opinion rather than strong evidence
Indications
- Clinical tension pneumothorax
Contraindications
- Local trauma: possibility of sharp bone fragment/foreign body
Equipment Needed
- sterile gloves
- scalpel
- Kelly clamp
- betadine
- lidocaine, syringe, needle
Procedure
- Recognize possible tension physiology.
- Locate 5th intercostal space at anterior/mid-axillary line.
- Clean with betadine.
- Consider lidocaine/local anesthetic: reconsider if in a trauma code, or based on urgency of access/stability of patient.
- If patient is awake/alert, anesthetize the skin, muscle and down to pleura.
- Don sterile gloves.
- Using a No. 10/11 scalpel, make a 4cm through skin over and parallel to the superior border of the inferior rib.
- Using Kelly clamps, quickly blunt dissect through subcutaneous tissue and muscle just over the superior border of the inferior rib.
- With closed Kelly clamps, puncture through the parietal pleura.
- the "give" of the parietal pleura indicates access of the pleural space
- if tension hemopneumothorax is present, you may hear a "whoosh" of air or note swift return of blood
- Remove the Kelly clamps from the tract and insert your full gloved finger into the space.
- intrapleural palpation confirms access of the pleural space
- re-expansion of the lung parenchyma may be palpated, especially if patient is receiving positive pressure ventilation (e.g. intubated)
- If lung is already expanded on palaption and there is no forceful air/fluid release, it may be possible to close the thoracic wound with occlusive dressing, obviating further tube thoracostomy.
- If tension physiology confirmed on finger thoracostomy, place an urgent chest tube when resuscitation allows.
Advantages
- advantages over needle thoracostomy:
- unlimited by needle length
- observable signs confirming pleural access
- puncture sensation of parietal pleura with Kelly/finger
- palpation of parietal pleura with finger
- palpation of lung parenchyma with finger
- if no pneumothorax, will not puncture lung parenchyma to create new pneumothorax
- theoretically does not require placement of chest tube if no initial pneumothorax
- no chance of catheter "kinking"
- advantages over tube thoracostomy
- simpler: quicker, easier, less equipment
- no foreign body, decreased infection
Disadvantages
- slower to perform than needle decompression
- more steps/equipment than needle decompression
- no tube holding tract open; may seal off during resuscitation/movement/transport
See Also
External Links
- https://emcrit.org/emcrit/needle-finger-thoracostomy/
- http://regionstraumapro.com/post/38306629710
- http://www.tamingthesru.com/blog/acmc/finger-thoracostomy
References
- Fitzgerald M, Mackenzie CF, Marasco S, Hoyle R, Kossmann T. Pleural decompression and drainage during trauma reception and resuscitation. Injury. 2008 Jan;39(1):9-20. doi: 10.1016/j.injury.2007.07.021. Review. PubMed PMID:18164300.
- Stevens RL, Rochester AA, Busko J, Blackwell T, Schwartz D, Argenta A, Sing RF. Needle thoracostomy for tension pneumothorax: failure predicted by chest computed tomography. Prehosp Emerg Care. 2009 Jan-Mar;13(1):14-7. doi: 10.1080/10903120802471998. PubMed PMID: 19145519.
- Ball CG, Wyrzykowski AD, Kirkpatrick AW, Dente CJ, Nicholas JM, Salomone JP, Rozycki GS, Kortbeek JB, Feliciano DV. Thoracic needle decompression for tension pneumothorax: clinical correlation with catheter length. Can J Surg. 2010 Jun;53(3):184-8. PubMed PMID: 20507791; PubMed Central PMCID: PMC2878990.
- Zengerink I, Brink PR, Laupland KB, Raber EL, Zygun D, Kortbeek JB. Needle
thoracostomy in the treatment of a tension pneumothorax in trauma patients: what size needle? J Trauma. 2008 Jan;64(1):111-4. doi: 10.1097/01.ta.0000239241.59283.03. PubMed PMID: 18188107.
- Deakin CD, Davies G, Wilson A. Simple thoracostomy avoids chest drain insertion in prehospital trauma. J Trauma. 1995 Aug;39(2):373-4. PubMed PMID:7674410.