Indications for Needle Decompression

  • Tension pneumothorax

Contraindications to Needle Decompression

  • None since this is a life-saving procedure

Equipment for Needle Decompression

  • An 8 cm 14- or 16-gauge angiocatheter 
  • Sterile gloves
  • Mask
  • Eye protection
  • Antiseptic solution such as 2% chlorhexidine solution (or betadine)
  • 1% lidocaine

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Complications of Needle Decompression

  • Punctured lung
  • Injury to intercostal artery or vein

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.