Template:Needle aspiration of pneumothorax: Difference between revisions
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===[[Reexpansion pulmonary edema]]=== | ===[[Reexpansion pulmonary edema]]=== | ||
*Incidence may be as low as 1% or as high as 14%<ref>Mukhopadhyay A, Mitra M, Chakrabati S. Reexpansion pulmonary edema following thoracentesis. J Assoc Chest Physicians [serial online] 2016 [cited 2018 Oct 11];4:30-2. Available from: http://www.jacpjournal.org/text.asp?2016/4/1/30/159871.</ref> | *Incidence may be as low as 1% or as high as 14%<ref>Mukhopadhyay A, Mitra M, Chakrabati S. Reexpansion pulmonary edema following thoracentesis. J Assoc Chest Physicians [serial online] 2016 [cited 2018 Oct 11];4:30-2. Available from: http://www.jacpjournal.org/text.asp?2016/4/1/30/159871.</ref> | ||
*Typically progresses over 2 days with opacities in previously collapse lung, with subsequent rapid reversal | |||
*To avoid this complication, consider using a small bore chest tube | *To avoid this complication, consider using a small bore chest tube | ||
*Other strategies include applying water seal only or attaching only a Heimlich valve without suction | *Other strategies include applying water seal only or attaching only a Heimlich valve without suction | ||
*If development occurs, treatment is supportive as is with other forms of noncardiogenic pulmonary edema | *If development occurs, treatment is supportive as is with other forms of noncardiogenic pulmonary edema | ||
**If a patient requires intubation, positive pressure ventilation improves symptoms after 24-48 hours | |||
*Risk factors are poorly understood but may include: | *Risk factors are poorly understood but may include: | ||
**PTX > 30% in size | **PTX > 30% in size | ||
**PTX symptoms for prolonged time, > 3 days | **PTX symptoms for prolonged time, > 3 days | ||
Revision as of 17:27, 17 October 2018
Needle Aspiration of Pneumothorax
- Use thoracentesis or "pig-tail" kit, if available
- Place in 2nd IC space in midclavicular line or 4th/5th IC space in anterior axillary line
- Withdraw air with syringe until no more can be aspirated
- Assume a persistent air leak (failure) if no resistance after 4 liters of air has been aspirated AND the lung has not expanded
- Once no further air can be aspirated:
- Option 1
- Place closed stopcock and secure catheter to the chest wall
- Obtain CXR four hours later
- If adequate lung expansion has occurred, remove catheter
- Following another two hours of observation, obtain another CXR
- If the lung remains expanded, may discharge patient
- Option 2
- Leave catheter in place
- Attached a Heimlich (one-way) valve
- May discharge with follow-up within two days
- Option 1
Reexpansion pulmonary edema
- Incidence may be as low as 1% or as high as 14%[1]
- Typically progresses over 2 days with opacities in previously collapse lung, with subsequent rapid reversal
- To avoid this complication, consider using a small bore chest tube
- Other strategies include applying water seal only or attaching only a Heimlich valve without suction
- If development occurs, treatment is supportive as is with other forms of noncardiogenic pulmonary edema
- If a patient requires intubation, positive pressure ventilation improves symptoms after 24-48 hours
- Risk factors are poorly understood but may include:
- PTX > 30% in size
- PTX symptoms for prolonged time, > 3 days
- ↑ Mukhopadhyay A, Mitra M, Chakrabati S. Reexpansion pulmonary edema following thoracentesis. J Assoc Chest Physicians [serial online] 2016 [cited 2018 Oct 11];4:30-2. Available from: http://www.jacpjournal.org/text.asp?2016/4/1/30/159871.