| PLEURAL DECOMPRESSION PROCEDURE Indications: A. Tension pneumothorax. B. Under special circumstances by direct physician order. Symptoms (Tension Pneumothorax): A. Diminished or absent breath sounds. B. Tracheal deviation. C. Tachycardia. D. Hypotension. E. Anxiousness (secondary to shock) F. Subcutaneous emphysema. G. Distended neck veins. H. Pale and/or cyanotic. I. Diaphoretic. Technique: A. Put patient on oxygen per non-rebreather mask. B. Obtain order from Medical Control. C. Gather equipment. 1. Large bore IV catheter - 16 ga. or 14 ga. 2. Iodine swabs. 3. Dressing and tape. 4. Flutter valve (finger from exam glove). 5. Rubber band to secure flutter valve. D. Position patient in a semi-upright position - if C-spine injury has been ruled out. E. Identify landmarks. 1. Mid-clavicular line (MCL)/Midaxillary line (MAL). 2. Second or third intercostal space (ICS) - feel for rough area on sternum at 3/4" below suprasternal notch. This is the angle of Louis and should correspond to the area of the second or third rib. Also, count the ribs to assure proper location. F. Prep the area with betadine iodine. G. Insert catheter into rubber glove finger and pierce the finger tip. Secure the flutter valve to the catheter with the rubber band. H. Insert the catheter over the top of the rib until air rushes out. Remove needle leaving catheter in place. I. Reassess breath sounds and patient's condition (condition of patient should improve almost immediately). J. Secure catheter with tape. K. Remember, the patient may need to have both sides of chest decompressed due to bilateral pneumothorax. Possible complications of procedure: 1. Pneumothorax 2. Hemothorax 3. Dyspnea 4. Cardiac tearing 5. Hypotension 6. Shock NOTE: Remember to go just above the rib due to all of the major structures - arteries, veins, and nerves which lie below the rib. The closer you stay to the top of the rib, the less chance of complications. Back to Medical Control Authority Home Page
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