Emergency thoracocentesis

USE

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

DESCRIPTION

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

METHOD

  • 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

OTHER INFORMATION

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

COMPLICATIONS

  • failure
  • local haematoma
  • pneumothorax
  • lung laceration

VIDEO

Michael McGonigal describes emergency needle thoracocentesis:


CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the  Clinician Educator Incubator programme, and a CICM First Part Examiner.

He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.

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

On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.