Tension Pneumothorax Decompression

Question 1

Indications.

Answer 1

Suspected tension pneumothorax including Traumatic Cardiac Arrest.

Question 2

Contraindications.

Answer 2

The ARS may not be appropriate for paediatric/small patients. Use Optiva 14g or 16g decompression needle depending on pts size.

Question 3

Precautions.

Answer 3

1. TPT decompression is a low volume/high risk skill performed in high pressure circumstances and requires regular practice to maintain familiarity with locating appropriate physical landmarks and familiarity with the equipment.
2. If both sides of the chest are being decompressed, the right should be done first to minimise risk of heart puncture.
3. Once inserted, if air, or air/blood bubbles or no air detected, leave in situ. If copious blood flows out, remove cannula and cover insertions site with occlusive dressing.
4. There is risk of body fluid being expelled under pressure during procedure and CPR.
5. This procedure is monitored through the Limited Occurrence Screening process.

Question 4

Equipment required.

Answer 4

Alcohol swab
ARS or cannula
Sharps container
Sterile gauze
Tape

Question 5

What might suggest a pt is retensioning?

Answer 5

Positive decompression but air flow or physical parameters decline.

Question 6

What problem-solving should be done if a pt is suspected to be re-tensioning?

Answer 6

Flush cannula with 5-10mL of Normal Saline.
If that is ineffective then perform a second decompression in close proximity to the original cannula on the lateral side.