# Needle Thoracostomy

## Overview

This module describes how to decompress a tension pneumothorax emergently and stabilise the patient until an intercostal drain can be established. For sampling fluid from the pleural space, see Thoracentesis.

## Indications

## Contraindications

## Patient information and consent

This procedure is usually done as an emergency measure. However, it may be explained to family members or the patient afterwards.

### How do I explain this procedure?

“The patient had a punctured lung, and the air from the puncture built up, squeezing the lungs and heart and putting their life at risk. I deflated this air pocket by puncturing it with a needle to reduce the pressure immediately. This was an emergency procedure.”

## Preparation

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### Documentation

### Equipment

## Site & Positioning

The patient should be positioned supine. The insertion site is the second intercostal space in the midclavicular line. Insert the cannula just

above

above

A neurovascular bundle runs on the inferior surface of each rib and directing the needle just superior to the underlying rib avoids damaging it.

the third rib.

## Procedure

Follow medical asepsis with non-sterile gloves.

## Troubleshooting

There is no rush of air.

In up to a third of patients, the chest wall may be too thick for the cannula to reach the pneumothorax. Proceed with an emergency intercostal drain.

After removal of the needle, the cannula has become kinked.

Insert a new cannula of the same size next to the first. Insert the intercostal drain as soon as possible.

There is a delay in placing a definitive drain.

Keep the patient under constant observation as the cannula may become obstructed while awaiting tube placement, or air in the pleura may accumulate faster than it can be expelled via the cannula. Multiple large-bore cannulas may be inserted but an intercostal drain is urgently needed.

## Risks

## References