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PR21: Needle Thoracentesis

Applicable To

Introduction

Indications

• Needle thoracentesis is indicated for the decompression of tension pneumothorax with deteriorating vital signs indicating markedly decreased cardiac output, profound shock, or cardiac arrest.  Bilateral decompression is also indicated in cases of blunt traumatic cardiac arrest. 

Contraindications

Procedure

1. Identify the insertion sites.  The preferred site is the fifth intercostal space on the mid-axillary line (in the diagram, this is the red line incorrectly labelled “AAL”).  An alternative placement is the second intercostal space on the mid-clavicular line.  The ARS needles used by BCEHS will be effective at either site.
2. Prepare the skin by cleaning it with an alcohol swab.
3. Remove the ARS needle and catheter from its protective case.  Puncture the skin, directing the needle above the inferior rib (blood vessels and nerves underlie the inferior border of each rib).  Air may be heard hissing as the needle passes into the pleural space.
4. Advance the catheter into the pleural space and remove the needle.
5. Leave the catheter open to air.  It is not necessary to place a chest seal over the catheter

Notes

Resources

References