Needle Thoracostomy (Internal Medicine)

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SAMPLE EXCERPT
- Full procedure text, video and illustrations available with the full product
PRE-PROCEDURE
INDICATIONS
  • Suspected or confirmed tension pneumothorax with signs of clinical deterioration.
CONTRAINDICATIONS
  • There are no absolute contraindications to needle thoracostomy.
  • No data exist on the safety of the procedure in patients with a coagulopathy; if it must be performed in these situations, meticulous attention must be paid to anatomy and technique.
EQUIPMENT
  • Skin-cleansing agent (chlorhexidine or povidone-iodine)
  • 14- to 16-gauge, 5-cm, over-the-needle catheter (catheters without safety devices are ideal)
  • 10-mL syringe (optional)
ANATOMY
  • Second intercostal, midclavicular approach (generally preferred)
    • The second rib articulates with the sternomanubrial joint. The second intercostal space lies below the second rib.
  • Fourth or fifth intercostal, midaxillary approach
    • The midaxillary portion of the fifth rib is generally at nipple level in most adults. The fourth and fifth intercostal spaces lay below the fifth and sixth ribs, respectively.

PROCEDURE
Sample excerpt does not include step-by-step text instructions for performing this procedure
The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

POST-PROCEDURE
CARE
  • Chest tube insertion is mandatory after needle thoracostomy.
  • Obtain a portable chest radiograph.
COMPLICATIONS
  • Failure to decompress the tension pneumothorax (try again with a longer catheter, or insert a chest tube)
  • Bleeding
  • Iatrogenic pneumothorax
  • Infection
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