Template:Needle aspiration of pneumothorax: Difference between revisions

Latest revision as of 21:01, 28 July 2021

Use thoracentesis or "pig-tail" kit, if available
Place in 2nd IC space in midclavicular line or 4th/5th IC space in anterior axillary line
Withdraw air with syringe until no more can be aspirated
- Assume a persistent air leak (failure) if no resistance after 4 liters of air has been aspirated AND the lung has not expanded
Once no further air can be aspirated:
- Option 1
  - Place closed stopcock and secure catheter to the chest wall
  - Obtain CXR four hours later
  - If adequate lung expansion has occurred, remove catheter
  - Following another two hours of observation, obtain another CXR
  - If the lung remains expanded, may discharge patient
- Option 2
  - Leave catheter in place
  - Attached a Heimlich (one-way) valve
  - May discharge with follow-up within two days
If 2.5 L of air has been aspirated, and a significant PTX remains, tube thoracostomy is indicated
NEJM video on needle aspiration of pneumothorax.

@@ Line 15: / Line 15: @@
 ***Attached a Heimlich (one-way) valve
 ***May discharge with follow-up within two days
+*If 2.5 L of air has been aspirated, and a significant PTX remains, tube thoracostomy is indicated
-===[[Reexpansion pulmonary edema]]===
+*[https://www.nejm.org/doi/full/10.1056/NEJMvcm1111468 NEJM video] on needle aspiration of pneumothorax.
-*To avoid this complication, consider using a small bore chest tube
-*Other strategies include applying water seal only or attaching only a Heimlich valve without suction
-*If development occurs, treatment is supportive as is with other forms of noncardiogenic pulmonary edema
-*Risk factors are poorly understood but may include:
-**PTX > 30% in size
-**PTX symptoms for prolonged time, > 3 days