25: Needle Thoracostomy (Perform)

Published on 07/03/2015 by admin

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Last modified 07/03/2015

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PROCEDURE 25

imageNeedle Thoracostomy (Perform)

PURPOSE:

Needle thoracostomy is performed to reduce a tension pneumothorax to a simple pneumothorax in a patient with a rapidly deteriorating condition. This temporary measure is followed quickly by the insertion of a chest tube for more definitive management.

PREREQUISITE NURSING KNOWLEDGE

• Anatomy and physiology of the pulmonary system should be understood.

• The thoracic cavity, in normal conditions, is a closed air space. Any disruption results in the loss of negative pressure within the intrapleural space. Air or fluid that enters the space competes with the lung, which results in collapse of the lung. Associated conditions are the result of disease, injury, surgery, or iatrogenic causes.

• A pneumothorax is classified as an open, closed, or tension pneumothorax. In patients with tension pneumothorax, air leaks into the pleural space through a tear in the lung and, with no means to escape from the pleural cavity, creates a one-way valve effect. With each breath the patient takes, air accumulates, pressure within the pleural space increases, and the lung collapses. As a result, the mediastinal structures (i.e., heart, great vessels, and trachea) shift to the opposite or unaffected side of the chest. Venous return and cardiac output are impeded, and the possibility of collapse of the unaffected lung exists.1–5

• Tension pneumothorax is a medical emergency that necessitates immediate intervention. Accurate assessment of signs and symptoms allows for prompt recognition and treatment:

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