Needle a Tension Pneumothorax

Needle thoracentesis is used to diagnose and treat a tension pneumothorax.

These patients typically experience significant respiratory distress and may also have:

Tracheal deviation
Unexplained hypotension
Unilateral absence of breath sounds
Presence of distended neck veins
Hypertympanic percussion note over affected side.

A 14 Gauge Angiocath-type (catheter over needle) needle is preferred, but any hypodermic needle can be effective. For this purpose, a larger bore needle is preferable to a smaller bore needle.

If available, administer oxygen 12 L/min using a non-rebreather mask or positive pressure with bag-valve-mask.
Locate the 2nd intercostal space in the midclavicular line on the side of the pneumothorax.
Clean area with betadine or other antiseptic.
Re-identify 2nd intercostal space in the midclavicular line.
Insert 14 gauge catheter over the top of the rib into the pleural space. This will avoid the blood vessels and nerves which run under the bottom of the rib.
Listen for a decompression air rush (hissing sound) from the needle, or aspirate as much air as necessary to relieve the patient's acute symptoms.
Leave the catheter in place and apply bandage or small dressing. A field-improvised one-way valve may be attached to the catheter.
Observe the patient and prepare for a chest-tube insertion if necessary.

The tension pneumothorax on the right demonstrates a collapsed right lung and deviation of the mediastinum to the left.

Insert a 14 gauge Angiocath-type needle through the 2nd intercostal space in the mid-clavicular line.

The 1st rib cannot normally be felt. The 2nd rib can be felt just below the collar bone. The 2nd intercostal space is the area between the 2nd and 3rd rib.

Identifiy the 2nd rib, 2nd intercostal space, and the mid-clavilicular line (center of the collar bone).
Insert the needle just over the 3rd rib, through the intercostal muscles and into the chest cavity.
A "hiss" of air confirms the presence of pneumothorax and is effective treatment for it.
Slide the catheter over the needle and into the chest cavity.
Attach a syringe and aspirate all the free air.
Leave the catheter and syringe in place so you can remove more free air as it accumulates.

This section developed from "Pararescue Medication and Procedure Handbook." US Air Force Special Operations Command, 720th Special Tactics Group, Hurlburt Field, Florida

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Bureau of Medicine and Surgery
Department of the Navy
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Operational Medicine
Health Care in Military Settings
CAPT Michael John Hughey, MC, USNR
NAVMED P-5139
January 1, 2001

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*This web version is provided by The Brookside Associates, LLC. It contains original contents from the official US Navy NAVMED P-5139, but has been reformatted for web access and includes advertising and links that were not present in the original version. The medical information presented was reviewed and felt to be accurate in 2001. Medical knowledge and practice methods may have changed since that time. Some links may no longer be active. This web version has not been approved by the Department of the Navy or the Department of Defense. The presence of any advertising on these pages does not constitute an endorsement of that product or service by either the US Department of Defense or the Brookside Associates. The Brookside Associates is a private organization, not affiliated with the United States Department of Defense.

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