Needle Thoracostomy

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Purpose (Description)

Indication

  • Immediate decompression of suspected tension pneumothorax

Contra-indication

  • Nil

Complications / Alerts

  • Complications

    • Intercostal nerve/artery injury – if the needle is placed beneath the rib

    • Pneumothorax may be induced if not already present

Preparation

  • Permission (Consent) [PRINTOUT]
  • Place
    • Any
  • Personel
    • Clinician competent to perform procedure
  • Positioning
    • Any position
  • Equipment needed [PRINTOUT]
    • 12-14 gauge IV cannula on fluid filled syringe
    • Skin prep
    • PPE – gloves
    • Drugs
      • Nil

Procedure

  • Pain control (Analgesia & Sedation)
    • Acute emergency procedure – none needed
  • Prep
    • Clean skin anterior/ superior chest wall
  • Process
    • Insert needle over superior aspect of 2nd rib, midclavicular line
    • Aspirate while inserting – stop when free air obtained
    • Thread cannula over needle & remove needle
    • Prepare & place formal tube thoracostomy
  • Problems?
    • May need longer needle in the obese patient or alternatively move to a lateral site
    • Some clinicians prefer a finger thoracostomy as a primary option, as the cannula might kink

Post Procedure Care

  • Dressings
    • Nil needed – remove catheter after tube thoracostomy placement
  • XR
    • Post tube thoracostomy placement CXR to check position
  • Documentation

Past the Basics