More information about Needle Decompression

Needle decompression is a procedure used to treat patients who have a tension pneumothorax. Tension pneumothorax is when air from the lungs escapes into the pleural space – which is in between the lungs and the chest. This normally happens when the lung suffers a puncture, and when the air enters the pleural space it cannot return due to the ‘one-way-valve’ system. If enough air enters the pleural space, the lung completely collapses and the pressure in the thoracic cage prevents the heart from filling up with blood. Needle decompression is required in these circumstances as positive pressure ventilation would exacerbate this ‘one-way-valve’ effect – a buildup of pressure in the pleural space would push the mediastinum to the opposite hemithorax, which in turn obstructs venous return to the heart. This can cause many complications such as circulatory instability, which can result in traumatic arrest and can ultimately be fatal. If left untreated, tension pneumothorax can lead to cardiovascular collapse, respiratory insufficiency which can lead to death.

There are a few causes of tension pneumothorax, the most common being blunt or penetrating chest trauma. This commonly occurs when there is a disruption of the visceral or parietal pleura, or can occasionally happen secondary to fractured ribs. Other causes can be barotrauma, central venous catheter placement, chest compressions and thoracic spine fractures. Common symptoms of tension pneumothorax vary as the condition advances. Early symptoms include chest pain, dyspnea, anxiety, tachycardia and tachypnea. If these symptoms are left to worsen, the person will display signs such as a decreased level of consciousness, hypotension, a swelling of the veins on the neck (this may not be present if hypotension has advanced) and cyanosis.

Needle decompression will quickly restore cardiopulmonary function, and reverses the physiologic effect of the tension pneumothorax. Needle decompression can indeed be life saving, however is not without its complications, so should be used by trained professionals. When administering needle decompression, the patient must first receive 100% oxygen, and must be informed to stay as still as they can. A 14 to 16 gauge angiocatheter is then inserted into the second rib space, in the mid-clavicular line. This is carefully administered until air can be aspirated into a syringe that is connected to a needle. If there is an immediate rush of air, this suggests a tension pneumothorax. A catheter is then advanced over the needle and left in place while a definitive chest tube is inserted on that side.

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