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
What position should the infant be placed in for pigtail catheter insertion?
Lateral position
What technique is used for placing the pigtail catheter?
Modified Seldinger technique
What is the purpose of the guide wire during pigtail catheter insertion?
To allow safe advancement of the catheter into the pleural space
What is an important step after inserting the needle during pigtail catheter insertion?
Apply negative pressure to a syringe while advancing the needle
What should be done if air or fluid is obtained during needle insertion?
Stop inserting the needle
What should be done after inserting the guide wire into the needle?
Remove the plastic sleeve carefully
What is a critical aspect of the dilating process for catheter insertion?
The site must be well dilated for the catheter to advance
What should be placed over the catheter insertion site after the catheter is inserted?
A clear occlusive dressing
True or False: Suturing is often needed for pigtail catheters.
False
What is a disadvantage of blunt entry thoracostomy compared to pigtail catheter insertion?
More invasive, more painful, and has more potential complications
What is the appropriate landmark for a blunt end thoracostomy placement?
Fourth or fifth intercostal space
What should be used for puncturing the pleura in blunt end thoracostomy?
The tip of forceps
What is the estimated depth of insertion for a chest tube in a small preterm infant?
Approximately 2 to 3 cm
What should be observed after connecting the chest tube to suction?
Bubbling in water seal
What should be documented after chest tube insertion?
Procedure, indication, complications, patient tolerance, updating of parents, pain management
What are potential complications of chest tube placement?
Misdiagnosis, trauma, nerve damage, infection, subcutaneous emphysema
Includes lung laceration, scarring, chylothorax, and misplacement outside pleural cavity.
Fill in the blank: The pigtail catheter is held in place by the skin, which acts as a _______.
Vice
