Needle Thoracostomy Location, Indications, Procedure | Needle Thoracostomy vs Chest tube

Tension pneumothorax is a medical condition that affects the patient severely if ignored for a long period. Needle thoracostomy is a temporary procedure done to cure or lessen the severity of this condition.

Tension Pneumothorax (TP) is a potentially fatal complication of chest trauma caused by lung collapse and mediastinal displacement away from the injured side, resulting in hypoxia. 

Hypoxia and circulatory collapse due to increased intrathoracic pressure and restricted venous return can cause death. Quick-release of intrapleural pressure can save a person’s life. 

Needle Thoracostomy Location

The temporary medical management for tension pneumothorax is needle thoracostomy (NT). This time-tested procedure can be carried out in a prehospital setting, on the battlefield, in an emergency room, or in an operating room. However, in some situations, such as in the prehospital setting, where the transit time is limited and there is no time to perform the treatment, needle thoracostomy may not be the best option.

Needle thoracotomy (NT) was first proposed as a quick and easy temporary procedure for chest decompression that might be used as a bridge to Tube Thoracostomy. Medical science has done a lot of work on Needle thoracotomy (NT) and there are different treatments for tension pneumothorax like video-assisted thorascopic drainage.

Needle Thoracostomy Location, Indications, Procedure | Needle Thoracostomy vs Chest tube   

Needle Thoracostomy Indications

Needle thoracostomy is indicated for emergency pneumothorax decompression. Shortness of breath, asymmetric lung sounds, a deviated trachea, crepitance, hypotension, blunt chest trauma, and Unstable hemodynamics are the indications of Needle Thoracostomy. 

Needle Thoracostomy Procedure

The following procedure is required for Needle Thoracostomy:

  1. Determine whether needle decompression of the chest is necessary.
  2. Ensure that basic life support, such as breathing management and bleeding control, is maintained.
  3. Assemble the necessary tools i.e. 16G or greater angiocath, alcohol wipes or betadine, the flutter valve and rubber glove finger tape.
  4. Take all precautions, including wearing eye protection.
  5. The entire chest should be exposed.
  6. The chest should be cleaned thoroughly with alcohol or betadine.
  7. Mid clavicular line second intercostal space should be located on the affected side
  8. Traumatic cardiac arrests are conducted through bilateral needle thoracostomy in the midclavicular line and second intercostal region.
  9. A thorough check-up of the patient is necessary to avoid the complications or need to re-examine the procedure. The procedure may need to be repeated if the catheter becomes kinked or blocked.
  10. Complete the initial care form with accurate documentation of the procedure.

Needle Thoracostomy vs Chest Tube

Thoracostomy is a minimally invasive operation in which a doctor inserts a small plastic tube into the pleural region. The doctors can connect the tube to a suction device to remove surplus fluid or air. They can also utilize the chest tube to inject drugs into the pleural area.

Chest tubes are often guided into place by imaging techniques such as computed tomography (CT), fluoroscopy, and ultrasound (US). In chest tube thoracostomy the pleural space is lined by two thin membranes i.e. one wraps around the lungs and the other lines the inner wall of the chest. On the other hand in needle thoracostomy, a wide-bore cannula is inserted right above the third rib.

Both needle Thoracostomy and tube thoracostomy are utilized to deal the traumatic patients. Trauma is the largest cause of death among those under the age of 40. Most thoracic injuries, however, can be treated adequately with a tube thoracostomy and needle thoracostomy.

Needle thoracostomy and chest tube thoracostomy are well-known medical procedures for curing Tension pneumothorax. Both the procedures differ in their initial management but the purpose of both the procedure is to relieve lung collapse. Needle thoracostomy is conducted by cleaning the skin in the upper chest, whereas Tube thoracostomy is accomplished by first situating the patient with the arm of the affected side over the patient’s head. It is critical to confirm the presence of pneumothorax before conducting the procedure.

The pieces of equipment required for needle thoracostomy and tube thoracostomy are different. Needle thoracostomy necessitates the use of a 12- to 16-gauge angiocatheter, whereas tube thoracostomy necessitates the preparation of the chest wall with povidone-iodine solution and a sterile zone in the fourth intercostal space.

Needle thoracostomy is not the best treatment for tension pneumothorax while chest tube thoracostomy is considered the best known medical procedure for curing the collapsed lung. Hence to generate the best results, the doctors prefer chest tube thoracostomy rather than needle thoracostomy. So, for efficient results, the clinician follows chest tube thoracostomy.

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