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11/13/24, 7\:24 PM Guide | Needle thoracocentesis (chest decompression)

Needle thoracocentesis (chest decompression)

Table of contents

Introduction

This guide provides a step-by-step approach to needle thoracocentesis (chest decompression) in an OSCE setting. It is NOT
intended to be used to guide patient care.
Conducting needle thoracocentesis may be assessed in an OSCE as an individual skill or as part of an ABCDE assessment.
You may also be interested in our guide to inserting a chest drain and the management of a pneumothorax.

Needle thoracocentesis

Needle thoracocentesis is a life-saving emergency procedure that involves placing a wide-bore needle, often a cannula, into
the chest cavity to decompress a tension pneumothorax or remove pleural e.
A tension pneumothorax occurs secondary to chest or respiratory insult, where air enters the pleural space but is unable to
leave, resulting in a rapid increase in intrathoracic pressure. Such impedance results in lung collapse and circulatory instability,
which eventually causes cardiac arrest.
Pleural e
the lung and the lubrication of the movement, resulting in further
Needle thoracocentesis provides a temporary but rapid and reliable release of air or
prevents further clinical deterioration allowing time to establish de

Indications

Tension pneumothorax
Pleural e

Contraindications

Simple pneumothorax
Features of a tension pneumothorax
Respiratory distress
Hyper expansion on the a
Bradycardia
Hypoxia
Tachycardia
Absent or diminished breath sounds
Hyper-resonance upon percussion of the a
Tracheal deviation away from the a
Jugular venous distention
Hypotension
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Gather equipment

Collect the equipment required for the procedure and place it within reach, ensuring all items are visible.
14G cannula or alternative needle decompression (e.g. TPAK chest decompression needle)
Alcohol swab (2% chlorhexidine gluconate in 70% isopropyl)
Syringe (10ml)
Non-sterile gloves
Sharps bin
Surgical tape or other methods of securing the cannula
Clean procedure tray (unlikely to be available in pre-hospital settings)

Paediatric patients

To avoid damage to intercostal vessels and underlying structures a smaller needle should be utilized in paediatrics.
Neonate / small infant (age 0-4)\: 24 – 22G
Age 5\: 20G / 3.2cm needle
Age 10\: 18G / 4.5cm needle
To avoid deep needle penetration insertion should be performed by aspiration of air via a syringe. Needle movement should be
immediately stopped after air is aspirated.

Introduction

Wash your hands using alcohol gel. If your hands are visibly soiled, wash them with soap and water.
Don PPE if appropriate.
Note\: needle thoracocentesis is a life-saving intervention performed on critically unwell patients, some of which may be
unconscious. Carrying out the following steps is good practice.
Introduce yourself to the patient, including your name and role.
Brie
“ I n e e d t o p e r f o r m a n i n t e r v e n t i o n t h a t w i l l
i n v o l v e i n s e r t i n g a n e e d l e i n t o t h e c h e s t t o r e l e a s e t r a p p e d a i r , a n d h e l p y o u b r e a t h e m o r e e
s m a l l s h a r p p a i n a s t h e n e e d l e i s i n s e r t e d .
”
Gain consent to proceed with the needle thoracocentesis.
Adequately expose the patient’s chest to identify the appropriate insertion point.

Identify an insertion site

Second intercostal space (mid-clavicular line)

1. Locate the suprasternal notch and move your nd
rib
2. From the angle of Louis move your
nd
intercostal space.
3. Run your
nd
intercostal space.
4. Insertion should be superior to the third rib border to avoid nerves, arteries and veins that pass here.

Fifth intercostal space (mid-axillary line)

1. Abduct the patient’s arm on the a
2. Insertion should take place within the triangle of safety identi
anterior border of Latissimus dorsi, superior 5 th
intercostal space.
3. Run your
4. Space should be identith
rib
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There is no signi
However, it is recommended that the anterior approach (second intercostal space) be attempted initially, and if unsuccessful
due to tissue or injury, the

Perform the procedure

1. Examine the chest and con
Identify the correct side of the chest for insertion
2. Clean the insertion site on the a
3. Remove the cannula sheath
4. Prepare cannula
Open the cannula wings if present
Slightly withdraw and replace the needle (this will allow it to glide more easily)
Unscrew the cap at the back of the cannula and attach a 10ml syringe
5. Insert 14g cannula at 90 o
into the insertion site. Insert through the chest wall structures towards the pleural space
Withdraw the plunger of the syringe until air or
6. Advance the cannula whilst removing the introducer needle and the syringe
7. Dispose of the introducer needle into the sharp container
8. Secure the cannula in place with tape to prevent it becoming dislodged
9. Con
Potential complications
Malposition\: if inserted in the wrong space leave the cannula in-situ and secure. Incorrect thoracocentesis may produce a
small pneumothorax; however, it is unlikely to be problematic in the context of a tension pneumothorax.
Obstruction of cannula\: aspirate with a syringe; if unsuccessful, insert a second needle close to the site.
Needle too short\: utilise the second insertion point at the 5 th
intercostal mid-axilla.
Displaced or removed cannula\: insert a second cannula, and secure appropriately.

To complete the procedure...

Dispose of your PPE and other clinical waste into an appropriate clinical waste bin.
Wash your hands.
Organise dechest drain insertion)

References

1. BMJ Best Practice. April, 2024. Available from\: [LINK]
2. 4. Gregory, P. M a n u a l o f C l i n i c a l P a r a m e d i c P r o c e d u r e s .
3. Joint Royal Colleges Ambulance Liaison Committee (JRCALC). N e e d l e T h o r a c o c e n t e s i s . 2024.
Journal of Paramedic Practice. N e e d l e d e c o m p r e s s i o n i n t e n s i o n p n e u m o t h o r a x \: a n t e r i o r o r l a t e r a l a p p r o a c h ? August, Available from\: [LINK]
2021.
5. Royal College of Emergency Medicine. T h o r a c i c T r a u m a . August, 2023. Available from\: [LINK]
https\://app.geekymedics.com/osce-guides/clinical-procedures/needle-thoracocentesis-chest-decompression/ 3/411/13/24, 7\:24 PM Guide | Needle thoracocentesis (chest decompression)
6. Scandinavian Journal of Trauma & Resuscitation Emergency Medicine. Determining optimal needle size for decompression of
tension pneumothorax in children – a CT-based study. October 2019. Available from\: [LINK]
7. British Thoracic Society. Management o f s p o n t a n e o u s p n e u m o t h o r a x \: B r i t i s h T h o r a c i c S o c i e t y p l e u r a l d i s e a s e gu i d e l i n e . August
2010. Available from\: [LINK]

Reviewer

Wez Roberts
Specialist Critical Care Paramedic
Source\: geekymedics.com
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