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Needle thoracostomy


S/S of life-threatening tension pneumothorax, such as:

- Chest injury, either blunt or penetrating

- Sucking chest wound on side of suspected pneumothorax

- Progressive worsening dyspnea

- ↓ or diminished breath/lung sounds on the affected side

- Hypotension / Shock

- Distended neck veins (Jugular)

- Tracheal deviation away from the affected side


Standing Order:

- Traumatic Full Arrest in adult and peds (Bilateral needle T if trauma to both sides)

- If an MCI, remote rescue or tactically unstable scene proceed without BHC and document


Flutter valve or Cook Set (blue end attaches to tubing nearest pt,’airflow’ arrow points out away from pt, stopcock should be in “open” position, chest guard attaches at chest/cannula junction after insertion.



1.  Explain procedure and place pt. in upright position if tolerated.

2.  Assemble equipment:

     - 14 or 16 gauge, ≤ 2.5” needle and cannula with syringe attached (3.25” ARS needle)

     - If pt. < 40 kg, use a 16g, 1.25” needle and cannula

     - Antiseptic wipes / 4x4s / tape

3.  Prep area with antiseptic wipes at 2nd intercostal space, mid-clavicular line.

4.  Insert needle perpendicular to the chest wall, at the level of the superior border of the 3rd rib until needle is in contact with rib.  Maintain negative pressure on the syringe while inserting the needle.

5.  Maintain needle in position, slowly “walk” the needle w/cannula over the superior border of rib and advance until the pleural space is entered by one or more of the following:

     - A “popping” sound or a “giving way” sensation

     - A sudden rush of air

     - Ability to aspirate free air into the syringe

6.  Remove needle; leave cannula in place.  DO NOT reinsert needle into cannula due to danger of shearing cannula. 

7.  Evaluate the effectiveness of the procedure by the immediate, obvious improvement in:

     - Respiratory status

     - Signs & symptoms

     - Vital signs

     - Lung sounds

8.  Add flutter valve to end of catheter (Only if using Cooks Set)

9.  Secure the cannula w/dressing and tape.


If there is no improvement, this procedure may be repeated

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