Needle Thoracostomy: Tape vs Commercial Seal
Question# 803
Version 5.1 of the ALS-PCS Companion Document states, "[a] chest seal blocks your view of the needle, and there is limited evidence to demonstrate a benefit" (p 41), and "secure the catheter in place with tape cravats" (p 116).
My service has not updated the contents of our chest needle decompression kits to remove Ashemans and add pink tape to be able to secure it with tape crevats. Does RPPEO have a stance on whether both techniques are valid?
My service has not updated the contents of our chest needle decompression kits to remove Ashemans and add pink tape to be able to secure it with tape crevats. Does RPPEO have a stance on whether both techniques are valid?
Answer:
Firstly, the RPPEO can help provide evidence-based best practices, but they are unable to change equipment of the various services. We recommend that you reach out to your manager regarding a review or change to your equipment if you believe a change is necessary.
The appendices of the ALS PCS Companion document are a great resource to review specific skills in a step-by-step way. In the Needle Thoracostomy section of Appendix A it goes through each step including equipment needed, preparation, and procedure of utilizing this skill. Best practice is to tape the chest needle catheter to the chest wall, for both a regular 14G thoracostomy device or the turkel device. Taping the catheter to the chest wall helps prevent it from being dislodged even if a commercial valve device is also used.
The research and evidence show that commercial devices are not necessary for the management of a tension pneumothorax, and this speaks to your question about the use of the Asherman and how it will block your view of the catheter. “In a patient with a tension pneumothorax who has undergone needle decompression and who is receiving positive pressure ventilation, a one-way valve is not needed, as the air flow is from internal to external. This is not the case with a sucking chest wound where the negative pressure on inspiration can cause air to be pulled into the chest. In this situation, a one-way valve should be used to cover the wound” (International Trauma Life Support, 2014). Other evidence has also shown the similar results, where Koch et al. state “to date, no randomized control trials on humans have been done to compare these devices (occlusive devices with valves, suction ports, and ventilated tracts), but multiple studies have been done in porcine models.” However, the Asherman is a useful adjunct if there is a worry that tape will not be sufficient, especially in patients where there is difficulty getting the tape to stick. It can also be useful for protection during extrication, packaging, and transfer, again, to help protect the catheter from dislodging. One study states, “the Asherman chest seal can easily be placed over the barrel of the thoracocentesis cannula and permits a more robust, easy, and readily available stabilisation device for the thoracocentesis cannula than tapes, gallipots, and syringe barrels, which are currently suggested” (Allison, Porter, & Mason, 2002).
Another great resource is the training package on needle thoracostomy located in MedicLEARN, Core CME, Fall 2022.
Therefore, in conclusion, the taping of the needle thoracostomy catheter is best practice whether you choose to use a commercial valve device or not. Additionally, if you think tape should be added to your needle thoracostomy kit for ease of access then reach out to your manager to discuss equipment changes.
The appendices of the ALS PCS Companion document are a great resource to review specific skills in a step-by-step way. In the Needle Thoracostomy section of Appendix A it goes through each step including equipment needed, preparation, and procedure of utilizing this skill. Best practice is to tape the chest needle catheter to the chest wall, for both a regular 14G thoracostomy device or the turkel device. Taping the catheter to the chest wall helps prevent it from being dislodged even if a commercial valve device is also used.
The research and evidence show that commercial devices are not necessary for the management of a tension pneumothorax, and this speaks to your question about the use of the Asherman and how it will block your view of the catheter. “In a patient with a tension pneumothorax who has undergone needle decompression and who is receiving positive pressure ventilation, a one-way valve is not needed, as the air flow is from internal to external. This is not the case with a sucking chest wound where the negative pressure on inspiration can cause air to be pulled into the chest. In this situation, a one-way valve should be used to cover the wound” (International Trauma Life Support, 2014). Other evidence has also shown the similar results, where Koch et al. state “to date, no randomized control trials on humans have been done to compare these devices (occlusive devices with valves, suction ports, and ventilated tracts), but multiple studies have been done in porcine models.” However, the Asherman is a useful adjunct if there is a worry that tape will not be sufficient, especially in patients where there is difficulty getting the tape to stick. It can also be useful for protection during extrication, packaging, and transfer, again, to help protect the catheter from dislodging. One study states, “the Asherman chest seal can easily be placed over the barrel of the thoracocentesis cannula and permits a more robust, easy, and readily available stabilisation device for the thoracocentesis cannula than tapes, gallipots, and syringe barrels, which are currently suggested” (Allison, Porter, & Mason, 2002).
Another great resource is the training package on needle thoracostomy located in MedicLEARN, Core CME, Fall 2022.
Therefore, in conclusion, the taping of the needle thoracostomy catheter is best practice whether you choose to use a commercial valve device or not. Additionally, if you think tape should be added to your needle thoracostomy kit for ease of access then reach out to your manager to discuss equipment changes.
References
Allison, K., Porter, K. M., & Mason, A. M. (2002). Use of the Asherman chest seal as a stabilisation device for needle thoracostomy. Emergency Medicine Journal. doi:https://doi.org/10.1136/emj.19.6.590
Internaltional Trauma Life Support. (2014). Needle Decompression of the Tension Pneumothorax. Retrieved from https://www.itrauma.org/wp-content/uploads/2014/05/Needle-Decompression-Resource-Document-FINAL.pdf
Koch, B., Howell, D., & Kahwaji, C. (2023). EMS Pneumothorax. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK482161/
Internaltional Trauma Life Support. (2014). Needle Decompression of the Tension Pneumothorax. Retrieved from https://www.itrauma.org/wp-content/uploads/2014/05/Needle-Decompression-Resource-Document-FINAL.pdf
Koch, B., Howell, D., & Kahwaji, C. (2023). EMS Pneumothorax. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK482161/