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Needle Chest Decompression

Clinical Indications:

    Patients with hypotension (SBP less than 90), clinical signs of shock, and at least one of the following signs:
      Jugular vein distention.
      Tracheal deviation away from the side of the injury (often a late sign).
      Absent or decreased breath sounds on the affected side.
      Hyper-resonance to percussion on the affected side.
      Increased resistance when ventilating a patient.

Procedure:

    1. Don personal protective equipment (gloves, eye protection, etc.).

    2. Administer high flow oxygen.

    3. Identify and prep the site:
    Locate the second intercostals space (ICS) in the mid-clavicular line on the same side as the pneumothorax. If unable to place anteriorly, lateral placement may be used at the fourth ICS mid-axillary line. Prepare the site with providone-iodine prep or solution.

    4. Insert the catheter (14 gauge 3.25-4 inch needle for adults ,Pediatric use 16-18 gauge, 2 inch needle) into the skin over the third rib and direct it just over the top of the rib (superior border) into the interspace.

    5. Advance the catheter through the parietal pleura until a pop is felt and air or blood exits under pressure through the catheter, then advance catheter only to chest wall.

    6. Remove the needle, leaving the plastic catheter in place.

    7. Secure the catheter hub to the chest wall with dressings and tape.

    8. Consider using a finger cot cut from an exam glove as a flutter valve which affixes over the catheter hub. Secure the glove finger with tape or a rubber band. (Note: don't waste much time preparing the flutter valve; if necessary control the air flow through the catheter hub with your gloved thumb.)

Competency Based Skill Requirements:

    Maintain knowledge of the indications, contraindications, technique, and possible complications of the procedure.

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