II. Indications

  1. Tension Pneumothorax (or suspected Tension Pneumothorax in a decompensating patient)

III. Equipment

  1. Child: Size 14 gauge over the needle angiocatheter (5 cm)
  2. Adult: Size 10 gauge over the needle angiocatheter (7.6 cm, 3 inch)
    1. Needle decompression with 5 cm angiocatheter may fail in 50-60% of adults
    2. Some studies suggest use of longer needles (8 cm needles are associated with a 90% success rate in some studies)
      1. Aho (2016) J Trauma Acute Care Surg 80(2): 272-7 +PMID:26670108 [PubMed]
    3. Other studies suggest 5 cm catheters should be sufficiently long to reach the pleural space in most adult patients
      1. McLean (2011) Am J Emerg Med 29(9):1173-7 [PubMed]

V. Technique

  1. Images
    1. needleThoracostomySmall.png
  2. Insertion site
    1. Second intercostal space (over 3rd rib) immediately below clavicle (parallel to angle of manubrium)
    2. Mid-clavicular line (or nipple line)
  3. Insertion Procedure
    1. Insert angiocatheter immediately OVER the 3rd rib in midclavicular line
    2. Signs of needle entering the pleural space
      1. May feel pop as needle enters pleural cavity
      2. Rush of air, blood or other chest contents (wear Personal Protection Equipment)
      3. Vital Signs and clinical status may suddenly improve as Tension Pneumothorax is relieved
    3. On needle entering chest, hold angiocatheter firmly in place and withdraw needle
  4. Post-procedure
    1. Requires Chest Tube placement after initial needle decompression

VI. Resources

  1. Regions Trauma Professional's Blog (Michael McGonigal, MD) - Needle decompression
    1. http://www.youtube.com/watch?v=UvHJ4pjNh2Q

Images: Related links to external sites (from Bing)

Related Studies (from Trip Database) Open in New Window

Ontology: needle decompression of thorax (C2957460)

Concepts Therapeutic or Preventive Procedure (T061)
English needle decompression of thorax, needle decompression of thorax (treatment)