How for to insert the needle for decompression of a tension pneumothorax. I understand the procedure, im just confused on how far to insert the needle. I have read to advance it to the hub of the catheter or just until you hear the sound of air leaving? Can someone help me out with this?
needle decompression
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Put it to the hub. You won't likely hear air escaping from the catheter.
thank you, i guess my confusion comes from some people using a regular 14g needle and some places use a 10g needle that is almost twice as long i would be concerned of advancing to far. From what i understand is that you want the pleaural space not inside the lung?
The only times I've done it, the sound was akin to a tire being deflated through a 14ga. VERY noticable.
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To the hub. Most caths are barely (or not even) long enough to get through the chest wall.
MSDeltaFlt
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There are different cath lengths and different chest sizes with different chest wall thickness. Not to mention different severity of pneumo with varying sub Q air. In essence go until you hear air, chest excursion improves, and/or pt improves.
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I've done several (appropriate) and never once heard it. Guess my hearings not as good as I thought
Yeah, even if you use a 14G, it should be a 3" cath. The 1 3/4" may not be long enough on many patients. And yes, pleural space, not the lungs.
I've done several (appropriate) and never once heard it. Guess my hearings not as good as I thought
Yeah, even if you use a 14G, it should be a 3" cath. The 1 3/4" may not be long enough on many patients. And yes, pleural space, not the lungs.
Same here. Never heard air but it was placed properly and was effective.
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I have done 1 and assisted with 2. I could hear air on 2 of them. (The one I did and one I assisted with) all 3 were effective.
In the army, we use 14ga, 3 1/4'' needles. Definately don't go to the hub with those.
I always go just a few centimeters farther than when I feel the "pop" of entering the pleural space. Going in past that point won't make the air escape any faster. What you do with that catheter afterwards is different depending on SOP. Some secure in place, some just take out entirely and plug the hole till it's time to decompress again.
If you're concerned about a noisy environment, you can screw a 3cc or 10cc flush to the needle, and watch the bubbles.
I always go just a few centimeters farther than when I feel the "pop" of entering the pleural space. Going in past that point won't make the air escape any faster. What you do with that catheter afterwards is different depending on SOP. Some secure in place, some just take out entirely and plug the hole till it's time to decompress again.
If you're concerned about a noisy environment, you can screw a 3cc or 10cc flush to the needle, and watch the bubbles.
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The way I was taught was to use your judgement on how deep to go. We have options as to which catheter we use. Either 3" 14g or the standard 1 3/4" 14g depending on the patient's size. Insert it until you hear air or have an improvement in the patient's status then secure it in place.
I've never done it on a live human, so take my advice with a grain of salt.
Random question but it involves needle decompressions. One way valve, yes or no? I've heard arguments on both sides. We are required to use a valve.
I've never done it on a live human, so take my advice with a grain of salt.
Random question but it involves needle decompressions. One way valve, yes or no? I've heard arguments on both sides. We are required to use a valve.
There's still no consensus on this accross the board, but this is our rationale:
It takes as little as 10 mins for that catheter to get clogged up with congealed blood. The one way valve serves little purpose in this case. Also, regardless of whether or not it remains effective, a relapse of symptoms requires another decompression.
So dosen't really do any harm, but dosen't really do any good.
It takes as little as 10 mins for that catheter to get clogged up with congealed blood. The one way valve serves little purpose in this case. Also, regardless of whether or not it remains effective, a relapse of symptoms requires another decompression.
So dosen't really do any harm, but dosen't really do any good.
Christopher
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The physics of the situation dictate that a one-way valve is unnecessary for such a small opening in the chest wall.