The effective and reliable solution for pneumothorax

The ThoraQuik™ Chest Decompression Device is a purpose-made device that is quick and easy to use for treating pneumothorax and pleural effusions that overcomes the traditional shortcomings of using improvised equipment that are not fit for purpose.

 

Conceived by Dr Ian McNeil, a past Chairman of the British Assosciation for Immediate Care (BASICS) from his extensive experience attending the critically injured at the roadside, ThoraQuik™ has been thoroughly tested during it's development by other BASICS members.

 
 

The device incorporates a patented unique one-way valve to release the air from the chest cavity and prevent it from re-entering whilst it's atraumatic Veress needle tip automatically protects the lung from damage once it enters the chest cavity. In addition, it has been designed with an ergonomic hub with additional suture points if required that adheres firmly to the skin, reducing the likelihood that it can be dislodged during handling the casualty.

 

Using ThoraQuik for pneumothorax

Images are for illustration purposes only. For full instructions for use please go to our media page. Always refer to local policies.

 

Step 1

Attach the supplied syringe to the ThoraQuik™ primed with air or sterile saline.

Step 2

Identify landmarks for location of insertion and incise the skin using the scalpel supplied.

NOTE: ThoraQuik™ can be used without scalpel if required.

Step 3

Advance the device. As the ThoraQuik pierces the chest wall the atraumatic needle tip will retract.

Step 4

Once into the pleural space the atraumatic needle tip extends to minimise risk of trauma.

Step 5

Whilst advancing the needle, draw back on the syringe. When air or fluid is identified immediately cease advancement of needle.

Step 6

Unscrew needle from hub with counter clockwise action and remove adhesive backing tapes from underneath the hub.

Step 7

Advance the catheter over the needle and withdraw the needle completely and dispose of in a sharps bin. Ensure hub is securely fixed to the chest.

Step 8

Rotate valve to the flow position (one-way valve operation).

 

What is Needle Thoracentesis?

Needle thoracentesis (NT) is the insertion or a needle into the pleural space and the drainage of air that has accumulated which can be life-saving when a patient has a pneumothorax as it allows decompression, restoration of the circulatory system and improvement in ventilation. Traditional NT treatment using a large bore cannula or needle is adequate, but using the wrong size or an unsuitable product can lead to unnecessary problems.

 

The recommended treatment for suspected tension pneumothorax is immediate needle decompression 1,2,3. Typically, needles used are 3-6cm long1,2,3. These are not always long enough to reach the pleural space2 and so it is recommended that the minimum needle length should be at least 7cm. 

 

ThoraQuik™ is a purpose-made device to treat patients presenting with spontaneous, secondary or tension pneumothorax, or pleural effusions that overcomes these problems.

 

It is designed to treat all of these conditions efficaciously with it's large bore 10cm needle and unique built-in one-way valve ensuring success in reaching the pleural space and minimising the risk of catheter occlusion once it is found. In addition, it simultaneously ensures that it remains firmly secured, thus removing the potential problem of an open air passage into the chest cavity from the outside.

 

In the pre-hospital environment, if the procedure does not confirm the presence of air in the chest cavity the built-in one-way valve can be switched off and the device left in situ. This will alert the hospital receiving team to the fact a chest decompression has been attempted without compromising lung function, as is currently the case if an open-ended cannula is left in situ.

 

If the cannula becomes blocked or is suspected of being blocked, the syringe can be used to flush through the cannula and restore patency without compromising the seal.

 

The unitary design of ThoraQuik™ means the device can be used straight from the pack, rather than requiring the assembly of a kit of components. It can also be placed using a single hand enabling it's use in arduous and hostile environments such as with trapped victims of road traffic accidents or in military conflict situations.

 

Pneumothorax & Pleural Effusions - What are they?

Pneumothorax occurs when air becomes trapped between a lung and the chest wall, having entered this space either from the lungs or from outside the body.

Classifications of Pneumothorax are:

 

Primary spontaneous pneumothorax

Spontaneous pneumothorax develops for no apparent reason in an otherwise healthy person. This is the most common type of pneumothorax. It is thought to be due to a tiny tear of an outer part of the lung - usually near the top of the lung. It is often not clear why this occurs however, the tear often occurs at the site of a tiny 'bleb' or 'bullae' on the edge of a lung. The wall of the 'bleb' is not as strong as normal lung tissue and may tear. Air then escapes from the lung but gets trapped between the lung and chest wall.

 

Secondary spontaneous pneumothorax

This means that pneumothorax develops as a complication (a 'secondary' event) of an existing lung disease. This is more likely to occur if the lung disease weakens the edge of of the lung in some way. This may then make the edge of the lung more liable to tear and allow air to escape from the lung. For example, a pneumothorax may develop as a complication of COP (chronic obstructive airways disease) especially where lung bullae have developed in this disease. Other lung diseases that may be complicated by a pneumothorax include pneumonia, tuberculosis, sarcoidosis, cystic fibrosis, lung cancer and idiopathic pulmonary fibrosis.

 

Other causes of pneumothorax

An injury to the chest can cause a pneumothorax such as military trauma, injuries sustained in road traffic accidents or a penetrating injury to the chest. Surgical operations to the chest mat also cause a pneumothorax.

In cases where the air accumulates rapidly, a tension pneumothorax is present which need immediate attention. Untreated, pressure build-up will crush the blood vessels carrying blood back to the heart causing cardiac arrest that may be fatal within a few minutes.

 

Pleural effusions

The lungs are covered by a membrane or lining, called the pleura, which has an inner layer and an outer layer. The inner layer covers the lungs. The outer layer lines the rib cage and diaphragm, which is a sheet of muscle which separates the chest from the abdomen. 

The pleura produces a fluid which acts as a lubricant that helps you breathe easily, allowing lungs to move in and out smoothly. Sometimes, too much of this fluid can build up between the two layers of the pleura; this is called a pleural effusion.

 

1. David B. Wax, et al. (2007) Radiologic Assessment of Potential Sites for Needle Decompression of a Tension Pneumothorax. Anesthesia & Analgesia; Vol. 105, No. 5, pp. 1385-1388

2. Imme Zengerink, et al. (2008) Needle Thoracostomy in the Treatment of a Tension Pneumothorax in Trauma Patients: What Size Needle? The Journal of Trauma Injury, Infection, and Critical Care; Vol. 64, No. 1, pp. 111-114

3. S. Britten, et al. (1996) Needle Thoracocentesis in Tension Pneumothorax: Insufficient Cannula Length and Potential Failure. Injury: International Journal of the Care of the Injured; Vol. 27, No. 5