Syringe plunger aspiration technique (SPAT): a simple bedside and field technique for assessing pneumothorax

Abstract

Background: A simple technique for diagnosing pneumothorax caused by disease or trauma using the syringe plunger aspiration technique (SPAT) is discussed. It's simple, reproducible and can be helpful where radiographs are not readily available or inconclusive radiographic findings,in patients living at remote places and during mass casualty. Therapeutic needle aspiration is an established strategy for diagnosing pleural fluid collection but its place as a diagnostic tool for pneumothorax is unclear. SPAT minimizes any potential iatrogenic pneumothorax that may occur with a wide bore needle hence the use of size 21G needle and is a favorable screening test.
Objectives: The objective is to provide an easy, reliable appendage for assessing pneumothorax, determining its sensitivity / specificity, and to compare the efficacy of SPAT with other methods
Methodology: This study investigates pneumothorax diagnosis from 2010 to 2012 using 5mls syringe and needle (21G × 11/ “).The study method is a primary intervention one, where a 5mls 2 syringe and hypodermal needle (21G) were inserted at the 4th or 5th intercostal space between the anterior axillary line and midaxillary line under aseptic technique and the plunger drawn, in patients with suspicion of pneumothorax. The presence of aspirated air in the syringe from pneumothorax retains the plunger in place, preventing its retraction back.
Result: A total of 21 patients were reviewed. Syringe plunger aspiration technique's (SPAT) was carried out in all cases with sensitivity of 1, specificity of 0.66, positive predictive value (PPV) of 0.94, negative predictive value (NPV) of 1, and accuracy 0.95. The graduation on the syringe using SPAT was accurate in estimating massive pneumothorax in 4 patients as complete lung collapse by radiograph tally fully with plunger displacement exceeding the 5mls mark.
Conclusion: Our SPAT sensitivity of 100% makes it important as a screening test of pneumothorax where a missed diagnosis can have a grim consequences.