QS Study

Needle Thoracostomy

A needle thoracostomy is necessary for patients with tension pneumothorax (air in the pleural cavity under pressure) or to drain fluid (blood or pus) away from the pleural cavity to allow the lung to re-expand. It may also be necessary to withdraw a sample of pleural fluid for microbiologic examination. A tension requires immediate decompression using a needle thoracostomy. Pneumothorax may be small without conversion to tension, but when there is a significant and expanding amount of air trapped in the pleural cavity, the increasing pressure from this abnormal air causes the lung to shrink and collapse, leading to respiratory distress.

Needle Thoracostomy

Fig: Needle Thoracostomy Anatomical figure

Anterior Approach

For the anterior approach, the patient is in the supine position. The sternal angle is identified, and then the second costal cartilage, the second rib, and the second intercostal space are found in the midclavicular line.

Lateral Approach

For the lateral approach, the patient is lying on the lateral side. The second intercostal space is identified as above, but the anterior axillary line is used.

The skin is prepared in the usual way, and a local anesthetic is introduced along the course of the needle above the upper border of the third rib. The thoracostomy needle will pierce the following structures as it passes through the chest wall (a) skin, (b) superficial fascia (in the anterior approach the pectoral muscles are then penetrated), (c) serratus anterior muscle, (d) external inter-costal muscle, (e) internal intercostal muscle, (f) inner-most intercostal muscle, (g) endothoracic fascia, and (h) parietal pleura.

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