NEEDLE DECOMPRESSION - cont'd info

Indications for Needle Decompression

Contraindications to Needle Decompression

Equipment for Needle Decompression

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Complications of Needle Decompression

Proper positioning and technique for Needle Decompression

- Place the patient in a semi-upright position
- Keep the ipsilateral arm raised above the head if a mid-axillary approach is planned

Prep the skin with chlorhexidine swabs (or betadine if chlorhexidine is unavailable)

Use 1% lidocaine for anesthesia if time allows
Advance an 8 cm 14- or 16-gauge angiocatheter either over the third rib in the midclavicular line or over the fifth rib in the mid-axillary line
Remove the needle leaving the catheter in place and open to air
Note: once hemodynamically stable, the patient will require placement of a chest tube placed on the affected side.

Optimal sites for Needle Decompression

3rd intercostal space in mid-clavicular line
4th intercostal space in mid-axillary line
- The mid-axillary line location is preferred in obese patients, very muscular patients or those with abundant anterior chest wall tissue. The chest wall thickness tends to be thinner in the mid-axillary line in these patients.