Emergency thoracocentesis


  • Emergency thoracocentesis (thoracentesis) emergency decompression of a tension pneumothorax


  • insertion of a cannula into the pleural space to relieve a pressure in the pleural space


  • high flow O2
  • aseptic
  • patient supine or sitting up
  • 2nd intercostals space, midclavicular line
  • LA/GA
  • insert perpendicular to skin with a syringe of saline attached
  • insert needle over superior margin of rib
  • on insertion continually aspirate
  • once parietal pleural breached aspiration of air should be apparent
  • advance cannula into pleural space
  • allow decompression to take place
  • insert a formal chest drain and connect to an underwater seal drain
  • obtain CXR


  • may be ineffective in obese patients
  • ‘triangle of safety’ in the axilla is an alternative site of insertion


  • failure
  • local haematoma
  • pneumothorax
  • lung laceration


Michael McGonigal describes emergency needle thoracocentesis:

CCC 700 6

Critical Care


Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of three amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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