View Full Version : Needle thoracocentesis
Anyone done it?
Midclavicular or midaxillary?
I did for the first time on my last shift, and there was a pretty huge pucker factor. Writhing and severe crepitus at the midclavicular site forced me to go midaxillary. I heard a small escape of air, but couldn't aspirate much with the syringe, and that made me second guess myself for a moment, but then the pt. said he could breathe easier, slowed down his RR, sats picked up, return of LS, etc.
Just wondering what y'alls experiences were with this.
Good job :thumbsup:
I've done a dozen or so, and like you, my first one was accompanied by some serious pucker factor. That was the only one I did while working the streets--the rest have been since I've been flying. The most memorable was an ATV rollover with the ATV landing on the pt's chest. When I got in the back of the ambulance at the LZ, the pt was working pretty hard to breathe, hypotensive, tachy, pasty, and soaking wet. After I listened to his chest, I asked the medic if she had ever decompressed a chest, and she said no. I handed her a 10ga, helped her identify landmarks, we went with a mid-clavicular insertion, and reminded her not to stand over the angio. She did a fine job, and when she entered the chest, it literally blew the cap off the back of the angio and sprayed the ceiling. I just got air return from my side. Pt said he immediately was breathing better, and was ever so thankful. The medic had a grin from ear to ear.
The pt did not like the chest tubes near as much.
The instant results were very rewarding. Come to think of it, last shift was full of them- had an very sick SVT convert with Valsalva's maneuver too.
Thanks for the kind words- and yes, I think my ear to ear grin is still here.
I've never done one but nearly assisted with one. The only reason I say "nearly" is that the Flight Nurse didn't do one as we were 30 sec. from the ER doors. The ER Doc fairly quickly did a mid-axillary chest tube and there was immediate relief upon entering the pleural cavity. Come to think of it, I've seen this done a couple of times during my clinicals. Each time the relief was immediate. The procedure itself was obviously painful, but the patient improved markedly afterwards.
As I worked primarily IFT ALS, the prospects for me doing a Needle Thoracentesis was near nil.
I had a high speed ejection from an MVA that had bilateral pneumos. Got harder and harder to bag him until i decompressed both mid-clavicular. Nice and easy to bag him afterwards. He bled out on the way in from an aortic tear with the expected results.
Actually, a needle thoracostomy..but regardless, you did good. I've done lots of chest tubes, but only needled two chests. Good results (as far as the air rush), patients were basically dead when they got to the ED though.
Done 2, 2nd 1 being just last week. They seem to breathe easier afterward, go figure. Good job :thumbsup:
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