Needle Thoracocentesis

Indication
For rapidly deteriorating critical pt with a life-threatening tension pneumothorax.
If used and no tension pneumothorax is present, a pneumothorax and lung damage may occur.

1.  Assess chest and respiratory status.

2.  High flow oxygen.

3.  Identify 2nd intercostal space in midclavicular line on side of tension pneumothorax.
- your aim is for above surface of third rib
- don't go in the 1st space or subclavian vessels at risk

4.  Prep chest and infiltrate local.

5.  Place upright if c-spine injury excluded.

6.  Keeping needle in, insert 14g angiocath attached to a 5-10ml syringe into skin, directing just over (superior) to rib into the intercostal space.

7.  Puncture pleua.  Remove luer needle.  Aspirate gently.  Sudden escape of air indicates relief of tension pneumothorax.

8.  Advance plastic cannula off angiocath and leave in place, dressing the site.

9.  Prepare for chest tube insertion if required.

10. Connect chest tube to an underwater seal drain and then remove the angiocath.

11. Get an x-ray.

Complications
Local haematoma
Pneumothorax
Lung laceration