Needle thoracostomy
| Needle thoracostomy | |
|---|---|
| Other names: Needle decompression[1] | |
 | |
| 12.3 GA / 8 Fr, 14 GA / 6.3 Fr, and 16 GA / 5 Fr needles used for the procedure | |
 | |
| Specialty | Emergency medicine |
| Indications | Tension pneumothorax[1] |
| Steps | 1) Select and clean site[1] 2) Insert a large hollow needle and catheter just above the rib[1] 3) Remove the needle, leaving the catheter in place[2] |
| Success | Rush of air, improved vital signs[3] |
| Complications | Bleeding, infection, lung or diaphragm injury[1] |
Needle thoracostomy (NT) is a procedure used in the initial treatment of a suspected tension pneumothorax.[1] It is generally followed by placement of a chest tube.[1] Finger thoracostomy; however, may be preferred over needle thoracostomy.[4] It is a type of thoracostomy, along with chest tubes and catheter thoracostomy.[2]
Typically the procedure is carried out in the 2nd intercostal space mid clavicular line or the 4th intercostal space anterior axillary line.[1][5] If sufficient time is present, the area may be cleaned with chlorhexidine and local anesthetic injected.[1] A 12, 14, or 16 gauge hollow needle and catheter is than placed just above the rib.[1] Once air returns, the needle is removed while the catheter is left in the chest.[2]
Successful placement will often result in a rush of air and improved vital signs.[3] A chest X-ray is than carried out to verify improvement.[2] Complications may include bleeding, infection, and heart, lung, or diaphragm injury.[1][6] If someone did not previously have a pneumothorax, one may develop.[1]
Technique
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Typically the procedure is carried out in the 2nd intercostal space mid clavicular line or the 4th intercostal space anterior axillary line.[1][7] The 4th intercostal space anterior axillary line may have a higher chance of success.[7] If there is sufficient time, the area may be cleaned with chlorhexidine and local anesthetic injected.[1] A 12, 14, or 16 gauge hollow needle and catheter is than placed just above the rib.[1] Longer needs (>8 cm) are better than shorter ones (5 cm).[1] Once air returns, the needle is removed while the catheter is left in the chest.[2]
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Part of the thorax with skin and muscle cut away to show the location of the intercostal vein, artery, and nerve
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Intercostal space
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References
- ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 "How To Do Needle Thoracostomy - Pulmonary Disorders". Merck Manuals Professional Edition. Archived from the original on 20 June 2022. Retrieved 9 August 2022.
- ↑ 2.0 2.1 2.2 2.3 2.4 King, Christopher; Henretig, Fred M. (2008). Textbook of Pediatric Emergency Procedures. Lippincott Williams & Wilkins. p. 355, 365. ISBN 978-0-7817-5386-9. Archived from the original on 2022-08-10. Retrieved 2022-08-09.
- ↑ 3.0 3.1 Nagelhout, John J.; Plaus, Karen (11 February 2009). Nurse Anesthesia E-Book. Elsevier Health Sciences. p. 976. ISBN 978-0-323-08101-6. Archived from the original on 10 August 2022. Retrieved 9 August 2022.
- ↑ "Needle Thoracentesis". fpnotebook.com. Archived from the original on 15 December 2021. Retrieved 9 August 2022.
- ↑ Laan, DV; Vu, TD; Thiels, CA; Pandian, TK; Schiller, HJ; Murad, MH; Aho, JM (April 2016). "Chest wall thickness and decompression failure: A systematic review and meta-analysis comparing anatomic locations in needle thoracostomy". Injury. 47 (4): 797–804. doi:10.1016/j.injury.2015.11.045. PMID 26724173.
- ↑ Wernick, Brian; Hon, HeidiH; Mubang, RonnieN; Cipriano, Anthony; Hughes, Ronson; Rankin, DemichaD; Evans, DavidC; Burfeind, WilliamR; Hoey, BrianA; Cipolla, James; Galwankar, SagarC; Papadimos, ThomasJ; Stawicki, StanislawP; Firstenberg, MichaelS (2015). "Complications of needle thoracostomy: A comprehensive clinical review". International Journal of Critical Illness and Injury Science. 5 (3): 160. doi:10.4103/2229-5151.164939.
- ↑ 7.0 7.1 Laan, DV; Vu, TD; Thiels, CA; Pandian, TK; Schiller, HJ; Murad, MH; Aho, JM (April 2016). "Chest wall thickness and decompression failure: A systematic review and meta-analysis comparing anatomic locations in needle thoracostomy". Injury. 47 (4): 797–804. doi:10.1016/j.injury.2015.11.045. PMID 26724173.
External links
- Taming the SRU Archived 2020-07-16 at the Wayback Machine