National Patient Safety Alert: Blood control safety cannula & needle thoracostomy for tension pneumothorax (2 April 2020)

Summary

Tension pneumothorax can occur following chest trauma, respiratory disease and infection, or during resuscitation requiring invasive or non-invasive ventilation. It is a life-threatening condition resulting from a collapsed lung when air trapped in the pleural cavity compromises cardiopulmonary function.

Immediate temporary decompression is required to prevent cardiac arrest. This is commonly done by inserting a needle and cannula, usually used for intravenous access, through the chest wall into the pleural cavity (needle thoracostomy). The needle is withdrawn, and the cannula left in place to allow the trapped air to flow out. New blood control (closed system) intravenous cannulas are increasingly used in the NHS; at least 130 trusts bought a total of three million of them in the last year. They look very similar to both traditional and standard safety cannula (with needle guard or shield) but have an extra integral septum which closes when the needle is withdrawn and stops free flow in or out of the cannula. Flow is only possible once an intravenous line or Luer-lock syringe is attached to the hub, which opens the septum.

Blood control (closed system) cannulas help prevent blood spillage, exposure and contamination, when used for their intended intravenous purpose, but they cannot be used to decompress a pneumothorax without additional equipment. The main patient safety risks are:

• staff may select a blood control (closed system) cannula not realising its limitations for this procedure
• a blood control (closed system) cannula may wrongly be assumed to be functioning in a patient who is deteriorating rapidly
• a second needle might be introduced risking very significant damage to the lung as it reinflates.

Content

Actions

Identify if your organisation purchases blood control (closed system) safety cannula. If it does, for all clinical areas and teams likely to undertake needle thoracostomy, including ambulances, emergency departments (EDs), intensive care units, respiratory units or any unit providing invasive or non-invasive ventilation, including units for COVID-19 patients:

• Provide standard safety cannulas* for needle thoracostomy in appropriate trays, drawers, pockets, within emergency workspaces, emergency kit bags, and resuscitation trolleys, and clearly label ‘For use in tension pneumothorax’.
• Attach visible warnings/notices to cupboards, drawers, etc in these emergency workspaces, emergency kit bags, and resuscitation trolleys where blood control (closed system) cannula are stored stating: ‘Do not use for tension pneumothorax’, with a direction to where standard safety cannulas can be found.
• Amend labelling/checklists in store cupboards used to restock these resuscitation areas, emergency kit bags and resuscitation trolleys to ensure clear distinction between standard safety cannula and blood control (closed system) cannula.
• Inform clinical and materials management staff who restock these resuscitation areas, emergency kit bags and resuscitation trolleys of these changes.