Template:Needle aspiration of pneumothorax

Needle Aspiration of Pneumothorax

• 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

Reexpansion pulmonary edema

• Incidence may be as low as 1% or as high as 14%
  • Typically progresses over 2 days immediately after thoracentesis
  • Radiographic opacities in previously collapse lung
  • After 2 days, subsequent rapid improvement
• 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
  • If a patient requires intubation, positive pressure ventilation improves symptoms after 24-48 hours
• Risk factors are poorly understood but may include:
  • PTX > 30% in size
  • PTX symptoms for prolonged time, > 3 days