- Traumatic cardiac arrest with torso involvement
- Suspected tension pneumothorax with respiratory and/or haemodynamic compromise
- Patients not in cardiac arrest unless trained and authorised
- Consider ASMA consult in a patient with suspected tension pneumothorax and respiratory and/or haemodynamic compromise.
- Perform bilaterally in traumatic cardiac arrest
- A patient not in cardiac arrest can receive unilateral treatment on the affected side, with ASMA authorisation where applicable
- The site selected should be superior to the third rib to avoid trauma to intercostal blood vessels and nerves.
- Procedure can be repeated if tension pneumothorax redevelops.
- It is very difficult to detect breath sounds/chest rise and fall in Traumatic Cardiac Arrest, so tension pneumothorax should be assumed whenever there is trauma to the torso
- Use of the ARS 10g needle is the preferred item, however the 14g needle can also be utilised.
- Shorter cannulas are unlikely to penetrate into the plural space
- All relevant infection control methods to be utilised.
- Prepare equipment required:
- Alcohol/betadine swab
- ARS 10g needle or Angio Cath 14g needle**
- 10mL syringe & NaCl
- Stethoscope
** Use an alternative size needle if the primary item is obviously too long for the anatomical features of the patient (e.g. younger / frail etc.)
- Locate the specific landmark on the affected side: 2nd intercostal space, mid-clavicular line.
- Clean the landmark site with an alcohol/betadine swab.
- Connect the thoracocentesis needle to the 10mL syringe.
- Insert the needle at a 90° angle to the patient’s chest wall.
- While inserting the needle, aspirate the 10mL syringe. Resistance is felt until the cannula enters the pleural space and releases air and/or fluids.
- Repeat procedure for opposing pleura.
- Remove the needle leaving the cannula in place.
- Re-evaluate the patient.
- Auscultate the chest.
- If found that the pneumothorax re-tensions:
- Repeat the procedure leaving the initial cannula in situ.
- Insert second cannula immediately adjacent to the first.
- In noisy high-stress environments, release of air may be difficult to detect. Signs of success include an improving SpO2, easing respiratory effort and decreased airway pressures in ventilated patients.
- Document pertinent points as necessary
- Improper diagnosis and insertion of a pleural catheter may lead to the creation of a pneumothorax or tension pneumothorax
- Incorrect placement may result in life threatening injuries to the heart, lung or surrounding vessels.
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