Needle thoracocentesis for tension pneumothorax

In a patient with a suspected tension pneumothorax, traditional trauma teaching advocated for rapid decompression on the affected side with a 14-16G needle in the 2nd intercostal space in the mid clavicular line.

 

The issues

There is a growing body of evidence that this may be ineffectual, is often misplaced, and can cause iatrogenic injury to the great vessels and lung.1,2

From: Fitzgerald M, et al. Pleural decompression and drainage during trauma reception and resuscitation. Injury. 2008 Jan;39(1):9-20

While needle thoracentesis can be considered as a temporising measure, especially in situation where performing a standard chest decompression is not possible, a rapidly performed thoracostomy using a scalpel in the 4th-5th intercostal space in the anterior axillary line should be performed preferentially in patients with a suspected tension pneumothorax or massive haemothorax.

If a needle thoracocentesis is performed, many now advocate placement in the 5th intercostal space in the anterior axillary line.

 

References

  1. Fitzgerald M, et al. Pleural decompression and drainage during trauma reception and resuscitation. 2008 Jan;39(1):9-20.
  2. Major trauma: assessment and initial management. NICE guideline. Published: 17 February 2017 www.nice.org.uk/guidance/ng39

 

About this guideline

Published: February 2018

Author: Emma Batistich

Approved by: Northern Region Trauma Network, ADHB, WDHB, CMDHB, NDHB

Review due: 2 years