TRANSCRIPT
Dr. Reynolds
When a newborn’s life is threatened by a tension pneumothorax, it’s important to know how to perform a needle thoracentesis. In the delivery room, this may be the last procedure you do for the baby when all other interventions and medications fail to increase the heart rate above 60 beats per minute and establish spontaneous respirations.
To perform a needle thoracentesis, carefully follow these steps:
- Place a piece of 1 sq cm tape with a buddy tab over the baby’s nipple, to protect it and to avoid obscuring the nipple during draping, or when betadine is applied.
- Apply betadine in an increasingly circular fashion, starting in the anterior axillary line at the level of the baby’s nipple. This is the fourth or fifth intercostal space through which your needle will be placed. Keep in mind that betadine needs 60 seconds of contact time to sterilize the skin.
- At this point, it’s important to put on sterile gloves.
- If they’re available, use sterile towels to drape around the anticipated needle insertion site. Draping may be skipped if the needle thoracentesis must be done emergently to treat a tension pneumothorax causing cardiorespiratory collapse. In this situation, generously apply betadine to a wide area, and proceed with inserting the needle.
- Assemble the needle device. If you use an 18- or 20-gauge angiocatheter, confirm that you have extension tubing, 4 x 4 gauze, and scissors.
- Set the angiocatheter on the side. Connect a 10–15 cm long extension tubing to the 3-way stopcock attached to either a 20- or 30-ml syringe to aspirate air.
- Find the line where the baby’s nipple and the anterior axillary line meet. This is the fourth or fifth intercostal space where your angiocatheter will be placed.
- Using sterile gloves, insert the angiocatheter just over the rib and into the chest using a “Z” pattern. Using the Z-track tissue insertion technique will ensure there isn’t a direct route through the chest wall from the inside to the outside when you remove it.
- As soon as you enter the chest cavity, retract the angiocatheter needle in order to decrease the risk of injuring underlying structures such as the lung, heart, and blood vessels.
- Attach the assembled extension tubing, 3-way stopcock, and 30-ml syringe to the end of the angiocatheter.
- Aspirate air using a syringe.
- Expel air through the side port if more than one syringe full of air is aspirated.
- Record the amount of air obtained, and stop when air is no longer being aspirated.
- Check the baby for improved color, heart rate, pulse oximetry, and activity.
- If there is a large pneumothorax leaking air into the chest you will have to leave the angiocatheter inside until a chest thoracentesis can be done. To secure the angiocatheter, first cut the 4 x 4 gauze pads to the middle in a way that allows you to slide them around the angiocatheter. Secure the pads by taping them in place. With the angiocatheter secured, another team member can continuously or intermittently remove air so as to prevent a repeat needle thoracentesis with its increased risk of injury.
- When you are no longer aspirating air, quickly remove the angiocatheter and dress with an adhesive bandage.
- Wipe off the betadine to prevent the baby’s skin from drying out. This also prevents the baby’s skin from absorbing excess iodine, which can suppress thyroid function.
By following these steps, you will be able to treat a newborn suffering from a tension pneumothorax.