Needle Thoracostomy (Emergency Medicine)

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  • Suspected or confirmed tension pneumothorax with signs of clinical deterioration.
  • There are no absolute contraindications to needle thoracostomy.
  • No data exist on the safety of the procedure in patients with a coagulopathy; if it must be performed in these situations, meticulous attention must be paid to anatomy and technique.
  • Skin-cleansing agent (chlorhexidine or povidone-iodine)
  • 14- to 16-gauge, 5-cm, over-the-needle catheter (catheters without safety devices are ideal)
  • 10-mL syringe (optional)
  • Second intercostal, midclavicular approach (generally preferred)
    • The second rib articulates with the sternomanubrial joint. The second intercostal space lies below the second rib.
  • Fourth or fifth intercostal, midaxillary approach
    • The midaxillary portion of the fifth rib is generally at nipple level in most adults. The fourth and fifth intercostal spaces lay below the fifth and sixth ribs, respectively.

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  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

  • Chest tube insertion is mandatory after needle thoracostomy.
  • Obtain a portable chest radiograph.
  • Failure to decompress the tension pneumothorax (try again with a longer catheter, or insert a chest tube)
  • Bleeding
  • Iatrogenic pneumothorax
  • Infection
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