Needle thoracostomy

Indications

• Suspected tension pneumothorax needing immediate decompression
  • Blunt chest trauma, shortness of breath, asymmetric lung sounds, deviated trachea, crepitance, hypotension
• Hemodynamically unstable

Equipment Needed

• 5cm 14 to 16 gauge IV needle/catheter
• 5 or 10mL syringe

Procedure

• Insert 5 cm 14 to 16 gauge IV needle catheter attached to syringe along superior margin of 2nd or 3rd rib in midclavicular line
  • Evidence suggests lowest failure rate of needle decompression is at the 4th/5th rib space along the anterior axillary line
• Advance needle until air is aspirated to syringe
• Withdraw needle
• Leave angiocatheter open to air
• Immediate rush of air out of chest = tension pneumothorax
• Follow immediately with standard thoracostomy tube

Complications

• Kinking of catheter
• Dislodgement
• Recurrence of tension pneumothorax
• Lung laceration
• Air embolism

See Also

• Tension pneumothorax
• Finger Thoracostomy

References

• Roberts, 179
• Wolfson, 82, 129