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.