For rapidly deteriorating critical pt with a life-threatening
If used and no tension pneumothorax is present, a pneumothorax and lung
damage may occur.
1. Assess chest and
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
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
11. Get an x-ray.