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