Thoracentesis and thoracostomy Flashcards
What is the definition of a pulmonary air leak in neonates?
The extravasation of air into the lung parenchyma and pleural spaces
What is considered an essential competency for Neonatal Nurse Practitioners (NNPs)?
Emergency evacuation of pulmonary air
What should be performed prior to a thoracentesis or thoracostomy tube placement, unless in an emergency?
A time-out should be performed
What types of pain management should be considered for neonates before a thoracentesis?
- Local infiltration with xylocaine
- Opioid analgesia
List some risk factors that increase the likelihood of a pulmonary air leak in neonates.
- Respiratory distress syndrome
- Meconium aspiration syndrome
- Pneumonia and sepsis
- Need for mechanical ventilation
What are the clinical signs and symptoms of a pneumothorax in neonates?
- Respiratory distress
- Diminished breath sounds on affected side
- Diminished heart sounds
What additional signs may indicate a tension pneumothorax?
- Bradycardia and/or tachycardia
- Hypotension
- Cyanosis and/or poor perfusion
How can transillumination assist in confirming a pneumothorax?
The area will illuminate nicely in the presence of a pneumothorax
What imaging technique provides a definitive diagnosis for a pneumothorax?
Evaluation of a chest X-ray (CXR)
What are the indications for performing a thoracentesis or thoracostomy?
- Pneumothorax under tension
- Lung collapse with ventilation/perfusion abnormality
- Presence of a bronchopleural fistula
What conditions may indicate the need for evacuation of pleural fluid?
- Significant pleural effusion
- Empyema
- Chylothorax
- Extravasated fluid from a central venous line
- Extrapleural drainage after surgical repair of esophageal atresia
When might thoracentesis be preferred over immediate chest tube placement?
When prompt evacuation of air or fluid is needed and prep time for chest tube placement may have adverse impacts
What are some contraindications for thoracentesis or thoracostomy?
- Small air or fluid collection without significant hemodynamic symptoms
- Spontaneous pneumothorax likely to resolve without intervention
What are some complications associated with thoracentesis?
- Pain
- Misdiagnosis
- Lung or vessel perforation
What equipment is needed for a thoracentesis?
- Large syringe for air collection
- T-connector
- Butterfly needle or angio-catheter set-up
At which intercostal space should the needle be inserted for air removal during thoracentesis?
2nd Intercostal space (ICS) and mid-clavicular space
What is the technique for inserting a butterfly needle during thoracentesis?
Enter at a 45° angle, then decrease to a 15° angle
What is the recommended insertion technique to avoid nerve, vein, and artery damage?
Insert just above the rib
What should be done after inserting the angiocath during thoracentesis?
Slide cannula in, remove stylet, and attach t-connector with syringe
What should be monitored during the aspiration process in thoracentesis?
Vital signs and pulse oximetry
True or False: Excess aspiration during thoracentesis decreases the risk for lung perforation.
False
What is the advantage of using pigtail catheters for evacuation of pneumothorax?
Less painful and less invasive than traditional blunt end catheters
Pain management is still a priority during the procedure.
What should be administered prior to a pigtail catheter insertion to manage pain?
Local lidocaine and a systemic analgesic such as fentanyl
This should be given if possible before the procedure.
What is the first step in the pigtail catheter insertion technique?
Prepare for sterile procedure and gather equipment
