TPT w/ARS or IVC

Question 1

Indications

Answer 1

Susp. tension pneumothorax incl. in Traumatic Cardiac Arrest

Question 2

Contraidications

Answer 2

The ARS (Air Release System) may not be appropriate for paeds / small Pts (use 14G or 16G as req’d)

Question 3

Clinical Precautions

Answer 3

• TPT decompression is a low volume / high risk skill that requires regular practice and familiarity with equipment and physical landmarks
• if decompressing both sides, start with Pt right side to avoid puncturing heart
• once inserted, if air escapes +/- blood bubbles through cannula, or no air/blood seen, leave in situ
• if copious blood flows out, remove cannula and cover site with occlusive dressing
• risk of body fluid being expelled when procedure is initially done, or if CPR is subsequently performed

Question 4

Insertion of cannula

“SMART”

Answer 4

S-econd intercostal space
M-id clavicular line (avoiding medial placement)
A-bove 3rd rib (avoid neurovascular bundle)
R-ight angles to chest wall
T-owards body of vertebrae

Question 5

Equipment

Answer 5

*Adequate PPE
Chlorhex / alco swab
ARS needle / appropriate sized cannula
Sharps container
Sterile gauze
Adhesive tape

Question 6

Problem solving

Answer 6

If decompression initially positive, but air flow or Pt condition declines (suggesting re-tensioning):

• flush cannula with 5-10 mL N/S
• if flush ineffective, perform second decompression in close proximity to original cannula on lateral side
• reassess for positive response