Paper Chase 02 – Management of Spontaneous Pneumothorax with Pigtail Catheters

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Nurses Edition Commentary

Mizuho Spangler, DO, Lisa Chavez, RN, and Kathy Garvin, RN
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Rabbott -

Way back in the 70's, we had "S-needles" - a large bore S shaped needle such that, after a stab into the pleural space (guided by percussion in the days before ultrasound), one end would lie flat in the pleural space, and the other end flat against the chest wall. The luer lock was then jerry-rigged to a lacerated finger from a surgical glove, and later to a Heimlich valve. A couple good coughs, a repeat CXR, home you go, lad. This was in the days before EBM had entered the lexicon - this was pure LTISW (Let's Try It, See if it Works).

Rebecca W. -

Sending home a spontaneous pneumothorax with a heimlich valve can be great, until it's not. I had a patient being treated as an outpatient come in via EMS in extremis. Between his cyanosis from his hypoxia, the expanding subcutaneous emphysema, and his lack of blood pressure from the now-tension pneumothorax, we are talking a full on Veruca Salt style blueberry. The advantage of caring for this patient as an inpatient would hopefully include someone noticing that the pigtail had become dislodged, leading to much earlier intervention.

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