Needle and Tube Thoracostomy - Indications, Procedure, and Complications

What Is Meant by Needle and Tube Thoracostomy?

Needle and tube thoracostomy are medical procedures used to treat conditions that involve the area between the lungs and the chest wall known as the pleural cavity.

• Needle Thoracostomy: A needle thoracostomy involves inserting a needle through the chest wall into the pleural cavity to remove air or fluid that has accumulated there. This procedure is typically used in emergency situations to relieve tension pneumothorax, which is a life-threatening condition that occurs when air accumulates in the pleural cavity and compresses the area between the lungs and the chest wall making it difficult for the patient to breathe.

• Tube Thoracostomy: A tube thoracostomy involves inserting a chest tube through the chest wall into the pleural cavity to drain fluid or air that has accumulated there. This procedure is commonly used to treat conditions such as pneumothorax, hemothorax, and pleural effusion, which are conditions that involve the accumulation of air or fluid in the pleural cavity. The chest tube is typically left in place for several days until the air or fluid has been completely drained, and the lung has re-expanded.

What Are the Indications of Needle and Tube Thoracostomy?

The indications of needle and tube thoracostomy are as listed:

• Needle Thoracostomy: For the decompression in case of a tension pneumothorax (a condition where air accumulates in the pleural cavity and compresses the lung thus preventing the patient from breathing easily.

• Tube Thoracostomy: After a needle thoracostomy, a tube thoracostomy may be necessary for the treatment of other conditions such as simple pneumothorax (presence of air in the pleural cavity causing the lung to partially or completely collapse), traumatic hemothorax (accumulation of blood in the pleural cavity due to injury or trauma), or large pleural effusions (accumulation of excessive fluid in the pleural cavity) with evidence of respiratory compromise. In this procedure, a chest tube is placed into the pleural cavity through the chest wall to drain accumulated air or fluid. The chest tube is typically left in place for several days until the air or fluid has been completely drained, and the lung has re-expanded.

What Are the Contraindications of Needle and Tube Thoracostomy?

A needle and tube thoracostomy should be performed only after confirming the presence of a pneumothorax. This is because a pneumothorax can be easily confused with a pulmonary bleb or bullae, which are large air-filled spaces in the lung parenchyma commonly found in patients with chronic obstructive pulmonary disease, and thoracostomy may not be appropriate or effective for these conditions.

How Is Needle and Tube Thoracostomy Performed?

The basic steps involved in needle and tube thoracostomy are as follows:

Needle Thoracostomy:

1. The individual is positioned supine with the arm on the affected side raised above the head to expose the chest wall.

2. The area of the chest where the needle will be inserted is cleaned and sterilized with an antiseptic solution.

3. The physician identifies the correct location to insert the needle, which is typically in the second intercostal space in the midclavicular line.

4. A local anesthetic is injected to numb the skin and underlying tissue.

5. The needle is placed into the pleural cavity through the chest wall until air or fluid can be aspirated from the needle.

6. A catheter or tube may then be inserted into the pleural cavity through the needle to allow for continued drainage, if necessary.

Tube Thoracostomy:

1. The individual is positioned supine with the arm on the affected side raised above the head to expose the chest wall.

2. The area of the chest where the tube will be inserted is cleaned and sterilized with an antiseptic solution.

3. A local anesthetic is injected to numb the skin and underlying tissue.

4. The physician identifies the correct location to insert the chest tube, which is typically in the fourth or fifth intercostal space in the mid-axillary line.

5. A small skin incision is made and the chest tube is inserted through the chest wall and into the pleural cavity.

6. The chest tube is secured in place and connected to a drainage system to allow for the removal of air or fluid from the pleural cavity.

7. To limit the risk of infection, the chest tube is maintained in place until the air or fluid has been completely drained, and the lung has re-expanded.

In both procedures, the patient's vital signs are monitored throughout the procedure to detect any complications.

What Are the Complications of Needle and Tube Thoracostomy?

While both procedures are generally safe and effective, they can sometimes be associated with certain complications, including:

• Bleeding: During the procedure, there is a risk of bleeding from the insertion site. This risk can be increased if the patient is on blood-thinning medications or has a bleeding disorder.

• Infection: There is a risk of infection with any invasive procedure. The risk of infection can be minimized by using sterile technique during the procedure.

• Pneumothorax: Needle and tube thoracostomy are performed to treat pneumothorax, but they can also cause pneumothorax as a complication. This occurs when the lung is accidentally punctured during the procedure, causing air to leak into the pleural space.

• Air Leaks: In some cases, the chest tube may not effectively drain all of the air from the pleural space, leading to persistent air leaks.

• Lung Injury: There is a risk of lung injury during the procedure, especially if the lung is not fully collapsed before the chest tube is inserted.

• Nerve Injury: The nerves that run along the rib cage can be damaged during the procedure, causing pain and discomfort.

• Malposition of the Chest Tube: The chest tube can sometimes be inserted into the wrong location, which can reduce the effectiveness of the procedure or cause other complications.

Conclusion:

Needle and tube thoracostomy are important procedures where the pleural area has been drained of any air or fluid surrounding the lungs. While they are generally safe and effective, they can sometimes be associated with complications such as bleeding, infection, pneumothorax, lung injury, nerve injury, malposition of the chest tube, and persistent air leaks. Healthcare providers must take necessary precautions and closely monitor patients undergoing these procedures to prevent and manage any potential complications. With proper technique and careful monitoring, needle and tube thoracostomy can be successful in treating a variety of conditions related to the pleural space.