Overview
Needle Decompression is an emergency procedure used to treat tension pneumothorax by inserting a needle into the pleural space to release trapped air. It is a life-saving intervention.
Needle decompression is crucial for treating tension pneumothorax, which can rapidly lead to cardiovascular collapse and death. It provides immediate relief while definitive treatment is arranged.
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Indications
Life-threatening air trapping
Blunt or penetrating chest trauma
Complication of procedures
Primary or secondary pneumothorax
Cardiovascular compromise
Contraindications
Absolute Contraindications
Relative Contraindications
📋 Equipment Checklist
Check off items as you gather them:
Pre-procedure Preparation
Preparation includes rapid assessment, equipment preparation, and immediate intervention. Time is critical in this emergency procedure.Step-by-Step Procedure
Step 1: Rapid Assessment
Assess for tension pneumothorax signs: dyspnea, hypotension, tracheal deviation.
⚠️ Common Mistakes to Avoid:
- Delayed recognition
- Missed signs
💡 Pro Tip:
Look for tracheal deviation, decreased breath sounds, hyperresonance.
Step 2: Site Selection
Choose 2nd intercostal space, mid-clavicular line.
⚠️ Common Mistakes to Avoid:
- Wrong site selection
- Too low
💡 Pro Tip:
Use 2nd ICS, mid-clavicular line for optimal decompression.
Step 3: Skin Preparation
Quickly prep skin with antiseptic if time permits.
⚠️ Common Mistakes to Avoid:
- Inadequate prep
- Delay
💡 Pro Tip:
Do not delay for extensive prep in true emergency.
Step 4: Needle Insertion
Insert needle perpendicular to chest wall, over superior rib.
⚠️ Common Mistakes to Avoid:
- Wrong angle
- Vessel injury
💡 Pro Tip:
Insert over superior rib to avoid neurovascular bundle.
Step 5: Confirmation
Listen for air release, observe patient improvement.
⚠️ Common Mistakes to Avoid:
- No air release
- Wrong placement
💡 Pro Tip:
You should hear air release if tension pneumothorax is present.
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Post-procedure Care
Post-procedure care involves immediate chest tube insertion, monitoring for complications, and definitive treatment.Complications & Management
| Complication | Incidence | Signs | Management | Prevention |
|---|---|---|---|---|
| Lung injury | 5-10% | Hemoptysis, increased air leak | Monitor, chest X-ray | Proper technique, correct site |
| Vessel injury | 2-5% | Bleeding, hematoma | Pressure, monitoring | Correct site, proper technique |
| Infection | 1-3% | Erythema, purulent discharge | Antibiotics | Sterile technique when possible |
| Inadequate decompression | 5-10% | No improvement | Repeat or chest tube | Correct technique, proper site |
Clinical Pearls
Look for tracheal deviation, decreased breath sounds, hyperresonance.
Use 2nd ICS, mid-clavicular line for optimal decompression.
Do not delay for extensive prep in true emergency.
Insert over superior rib to avoid neurovascular bundle.
You should hear air release if tension pneumothorax is present.
Follow immediately with chest tube insertion.
Monitor for complications post-procedure.