Critical Care, Clinical Support & Special Operations Paramedics only
Suspected tension pneumothorax with respiratory and/or haemodynamic compromise
Ambulance Paramedics only
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.
Patient Factors & Considerations
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 the angio cath 14g needle, as shorter cannulas are unlikely to penetrate into the plural space
All relevant infection control methods to be utilised.
Prepare equipment required:
Angio Cath 14g cannula**
10mL syringe & NaCl
** Use an alternative size needle if the Angio-Cath 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 angio cath 14g cannula 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.