Peds Needle Decompression

[tskstorm]

I had a Pediatrics lecture last night, and it was briefly mentioned that kids are more susceptible to Pneumothorax than adults. This statement, got me to thinking, what size catheter we would need to use to decompress a child's chest? I would imagine different gauges, and lengths for different age/size kids but I have no reference point.

Has anyone done a pediatric decompression in the field ? what did you use?

Anyone have a good reference point/chart or is it a standard size?

Thanks!

[Timmy]

I guess it depends on what brand of tube your using and what the weight of the kid is.

I've read a peads book at work that had a table on what to use on patients based on weight. I only remember patients over 40KG got a 20 to 24 tube.

[Just Plain Ruff]

I had a Pediatrics lecture last night, and it was briefly mentioned that kids are more susceptible to Pneumothorax than adults. This statement, got me to thinking, what size catheter we would need to use to decompress a child's chest? I would imagine different gauges, and lengths for different age/size kids but I have no reference point.

Has anyone done a pediatric decompression in the field ? what did you use?

Anyone have a good reference point/chart or is it a standard size?

Thanks!

I have had one peds decompression in the field and I used a 20ga cath and followed it with a vaseline guaze over the catheter.

I seem to remember that a 20 gauge will work fine for kids.

The kid had a tension pneumo and I truly believe that my decompressing him initially saved his life, but the pediatric trauma center needs to take most of the credit.

[BushyFromOz]

While not something in my toolbox, our IC guys use a 16G cannula. I believe that anything smaller the surface area to volume ration of air moving through the cannula creates enough friction to almost stop any airflow leaing the cannula, a bit like not having blood flow out of an uncapped 24G

[Just Plain Ruff]

yeah anything bigger than a 20 ga. will work. At least that's what I remember my last lecture that I had from a peds critical care training team.

[Camulos]

The youngest I have stuck was around 7-8 years. Did it with a standard 14G. In hindsight this pt may not have had a TP however the signs were there so what is one to do? He certainly did have a pnemothorax after I was done making him into a dart board. Oops – Aren’t we supposed to follow the dictum Primum non nocere. :oops: But that’s another story and shall be told another time.

Back to this topic. I do wonder about how to safely decompress much younger children. I would assume that the length of the cannula used is probably irrelevant, as long as you are sensible and only insert as far as required to decompress a tension. I wonder whether the bore of the needle would be too big for say a six month old. I guess the gauge of needle would only theoretically be too big if it did not fit into the intercostal space where you were inserting it. On that measurement alone I don’t believe even a 14G would be too big. Having said that I’m looking at a 14G right now thinking I would have HUGE reservations sticking that in a six month old.

I noticed someone earlier state they used a 20G. My personal feeling is that a 20G may be too small. But it worked, so hey what do I know? I guess the correct answer might be somewhere between 14 – 18G. However it would be good to get some actual documentation on this though so I don’t have to rely on my “guesses”. Good question tskstorm as it has made me prepare for a situation I have luckily not encountered before. Better than sweating it at the time that’s for sure!!!

Whilst on this topic I wanted to raise another question. How do you detect a tension pneumo in an infant?

Interested to read the answers.

Stay safe,

Curse :evil:

[Mateo_1387]

Great topic. My local guideline directs us to use an 18gauge catheter for pediatric tension pneumothorax.

To take a wild stab at Curse's question about infant Tension Penumothorax.....

It will probably be associated with trauma, especially to the chest wall, imminent cardiac arrest, and probably diminished breath sounds when listening midaxillary, and shock. Being that we do not have the benefit of assessing the pediatric patient routinely, I guess to come to the conclusion of a Tension Pneumothorax, it will be more associated with clinical suspicion rather than strong evidence. For example, diminished breath sounds, and tracheal deviation may not be easy for us to detect because of limited exposure to pediatric patients. Other signs I figure will be present include respiratory distress, trauma to the chest wall, and shock.

[CTXMEDIC]

what age group of peds? 17days or 17 years? only guy i ever darted was in his fifties so cant say much about what id do. prob a 20-18g for a real little guy. regardless of the patients size, air has to get out, IMO anything smaller than 20 is pointless.

[CTXMEDIC]

Great topic. My local guideline directs us to use an 18gauge catheter for pediatric tension pneumothorax.

To take a wild stab at Curse's question about infant Tension Penumothorax.....

It will probably be associated with trauma, especially to the chest wall, imminent cardiac arrest, and probably diminished breath sounds when listening midaxillary, and shock. Being that we do not have the benefit of assessing the pediatric patient routinely, I guess to come to the conclusion of a Tension Pneumothorax, it will be more associated with clinical suspicion rather than strong evidence. For example, diminished breath sounds, and tracheal deviation may not be easy for us to detect because of limited exposure to pediatric patients. Other signs I figure will be present include respiratory distress, trauma to the chest wall, and shock.

true, true. also remember that a little guy has a weaker chest wall and that a traumatic injury sufficient enough to cause a tension pneumo will have also, most likely, cause damage to other structures as well.

[Just Plain Ruff]

Trauma to the chest or belly, kid looks like crap, o2 sat low, obtunded, hyperresonate chest sounds, you probably will not have absent breath sounds on either side, they will more than likely be very very diminished.

The kid I needled had nearly absent breath sounds on both sides. The heart was also very muffled. When I did the needle we nearly had immediate improvement in lung sounds, color improved, child did not become less obtunded because he was a traumatic brain injury anyway.

The child survived to need pemanent day care based on his injury.