Pediatric Needle Thoracostomy

Pediatric Needle Thoracostomy

Needle thoracostomy is a life-saving emergency procedure used to decompress tension pneumothorax in pediatric patients. It serves as a temporizing measure until definitive treatment with chest tube placement can be performed.

Key Concepts:

Emergency decompression procedure
Bridge to definitive management
Age-specific anatomical considerations
Requires immediate recognition of tension pneumothorax
Time-critical intervention

Indications & Assessment

Primary Indications:

Clinical Signs of Tension Pneumothorax:
- Respiratory distress
- Chest pain
- Tachypnea
- Tachycardia
- Hypoxemia
- Decreased breath sounds
- Hypotension
- Tracheal deviation (late sign)
Specific Scenarios:
- Trauma with deteriorating vital signs
- Failed mechanical ventilation
- Post-procedural complications
- Spontaneous tension pneumothorax

Assessment Parameters:

Age Group	Normal Vital Signs	Warning Signs
Neonate	HR: 120-160 RR: 40-60 BP: 60-90/30-60	HR >180 RR >70 SBP <60
Infant	HR: 100-140 RR: 30-50 BP: 80-100/40-70	HR >160 RR >60 SBP <70
Child	HR: 80-120 RR: 20-40 BP: 90-110/50-80	HR >140 RR >50 SBP <80

Procedure Technique

Anatomical Landmarks:

Primary Site:
- 2nd or 3rd intercostal space
- Midclavicular line
- Superior border of rib
Alternative Site:
- 4th or 5th intercostal space
- Anterior axillary line

Step-by-Step Procedure:

Preparation:
- Identify landmarks
- Rapid skin cleaning
- Prepare equipment
Execution:
- Insert needle perpendicular to chest wall
- Advance until air rush heard/felt
- Remove inner needle
- Secure catheter
Confirmation:
- Clinical improvement
- Air evacuation
- Breath sound changes

Age-Specific Considerations:

Age Group	Needle Size	Depth (cm)
Neonate	20-22G	1.5-2.0
Infant	18-20G	2.0-2.5
Child	16-18G	2.5-3.0
Adolescent	14-16G	3.0-4.0

Equipment & Preparation

Essential Equipment:

Basic Equipment:
- Age-appropriate catheter-over-needle
- Antiseptic solution
- Sterile gloves
- Gauze pads
- Tape
Emergency Equipment:
- Chest tube kit
- Suction apparatus
- Monitoring equipment
- Resuscitation equipment

Site Preparation:

Quick clean with antiseptic
Sterile field not required in emergency
Mark anatomical landmarks
Position patient appropriately

Complications & Management

Immediate Complications:

Complication	Management
Bleeding	Direct pressure Hemodynamic support Surgical consultation
Organ injury	Immediate assessment Surgical evaluation Stabilization
Catheter dislodgement	Repeat procedure Secure properly Consider chest tube

Delayed Complications:

Infection
Re-accumulation
Scarring
Chronic pain

Post-Procedure Care

Immediate Care:

Monitoring:
- Vital signs
- Respiratory status
- Catheter function
- Pain assessment
Documentation:
- Procedure details
- Clinical response
- Complications
- Follow-up plan

Definitive Management:

Chest tube placement planning
Imaging studies
Underlying cause treatment
Surgery if indicated

Follow-up:

Regular assessments
Wound care
Prevention strategies
Parent education

Further Reading