Needle Thoracocentesis - Pneumothorax

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Needle Thoracocentesis - Pneumothorax

Plan for definitive air evaculation, apply occlusive dressing if cannula removed

Redirect/advance needle or remove and repeat

Chest tube placement

Withdraw the needle and secure the cannula

Attach a 50 ml syringe to the 3-way stopcock and aspirate air until no more is present (max - 30 ml/kg or 2.5L)

Signs of tension pneumothorax

  • Distended neck veins
  • Reduced breath sounds
  • Deviated trachea
  • Worsening dyspnea
  • Hypotension

Inclusion Criteria
  • Tension pneumothorax with urgent hemodynamic instability
Exclusion Criteria
  • None

Air is easily aspirated?

Advance the needle at a slightly downward angle into the pleural space while aspirating the syringe (average 3 - 6 cm)

  • Position patient to gain access to their chest (usually sitting at 45 degrees unless specific reason such as trauma)
  • Attach a large bore cannula (12 - 18 gauge) to 3-way stopcock and 5 ml syringe
  • Palpate the upper border of the 3rd rib to find the 2nd intercostal space in the midclavicular line
  • Sterilize the puncture site with providone-iodine or chlorhexidine
  • Puncture the skin perpendicularly at the 3rd rib and slide over the rib into the 2nd intercostal space

Consider chest tube placement