Tension pneumothorax is a potentially fatal condition that occurs following chest trauma. The condition occurs as a result of air being trapped within the pleural cavity. When not identified and managed on time, the affected person loses the oxygenation ability of their lungs, leading to death.
In this article, we will take a detailed look at this condition and specifically highlight the standard needle size for pneumothorax treatment.
Read on to get enlightened
What is pneumothorax?
Pneumothorax is a condition that causes air to take up part of the pleural cavity. This can occur in both closed and open chest walls.
The common signs and symptoms of a closed pneumothorax include dyspnea, chest pain, and tachypnea.
On the other hand, Pneumothorax in open chest walls occurs from the trauma that pierces the chest walls and pleural cavity.
How tension pneumothorax develops
Tension pneumothorax occurs when the lungs can no longer compensate, and oxygenation is impaired.
During inspiration, the pleural space fills with air, which is not completely removed during expiration.
The air occupying the pleural cavity collapses the lungs. As the lung on the injured side collapses, increased pressure is mounted on the uninjured side, causing a shift of the mediastinum to the uninjured side.
The combination of the collapsed lung and the shift in the mediastinum causes the injured person to struggle with oxygenation.
Cardiac output also reduces, because of the shift in the vena cava that returns blood to the heart. The different shifts in physiological processes result in tension pneumothorax.
In tension pneumothorax, core physiological processes like breathing and blood circulation are negatively affected. This is why death could easily result if the condition is not adequately managed.
Treating tension pneumothorax
To treat tension pneumothorax, we need two important components. They include
The Vented Chest Seal
and Decompression Needle
We will now take a look at both methods and how they work
The Vented Chest Seal
The goal of pneumothorax treatment is to free the pleural space of the air that enters into it.
This goal can be achieved by dressing the wound using materials with strong adhesives such as the vented chest seal.
This is a method of managing open pneumothorax.
If the patient continues to deteriorate even after efforts to seal the wound, efforts can be focused on directly removing the air from the pleural space.
This can be achieved by gently spreading the wound to aid the release of air from the pleural space.
Decompression Needle
Thoracostomy could also be carried out to release the air from the pleural space. Needle thoracostomy or needle decompression is the process of releasing air from the pleural space.
During needle decompression, a needle catheter is used to release the trapped air in the pleural space.
The needle is to be inserted into the second intercostal space on the midclavicular line. An audible release occurs after the needle is inserted into the pleural space.
Equipment for needle thoracostomy
Needle thoracostomy is an important process that could reverse a life-threatening condition.
The decompression needle has two parts: the needle part and the catheter part. Specifications of both parts differ and should be adhered to for the efficient management of tension pneumothorax.
According to the TCCC guidelines, the needle should be 14G, which is 2 inches, while the catheter maximum length 3.25".
Steps for needle decompression
Needle decompression should be precisely performed according to established protocols to avoid adverse effects.
If the needle is not properly positioned, for example, it could pierce a blood vessel or the heart, instead of the pleural spaces, and result in worse consequences.
Here are the steps that make up a well-established needle decompression protocol.
Step1: Start by trying to keep the patient oxygenated, if possible.
Step 2: Mark the point of insertion of the needle: the second intercostal space at the midclavicular line. The midclavicular line is the point where the nipple is located.
Step 3: Disinfect the site with povidone or alcohol. This is to prevent infection at the point of insertion of the needle.
Step 4: Prepare the needle, according to its requirements. You should remove the flash chamber or leur-lock, if it has any.
Step 6: Insert the needle at the point of insertion marked earlier. Ensure that the needle is 90 degrees to the chest wall. This is to prevent it from piercing other structures like the heart and major blood vessels. Watch out for the audible release of air.
Step 7: Dispose of the needle carefully, and leave the catheter in place. Secure the catheter in place to release all the air in the pleural space.
Step 8: Observe the patient for improved conditions. If the patient’s condition does not improve, insert another needle at a position adjacent to the initial one.
Conclusion
Tension pneumothorax occurs through both open and closed pneumothorax. If not managed effectively, this condition may lead to death. As stated above one way to effectively manage tension pneumothorax is through Needle decompression which is a simple process with lots of intricacies that must be mastered for the best outcomes. This process must be carried out carefully while keeping in mind that the choice equipment and adherence to established protocols determine the success of the procedure.