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Needle decompression of tension pneumothorax: animated demonstration

How to decompress a tension pneumothorax. Demonstrates insertion of a large-bore intravenous catheter into the fourth intercostal space in an adult.

Equipment needed

  • Sterile gloves, gown, and protective eyewear

  • Antiseptic for skin preparation

  • Large-bore intravenous catheter: 16-gauge or 14-gauge

  • 10 mL Luer lock syringe.

The second, definitive step of this procedure will be insertion of an intercostal chest drain. Be prepared to insert an intercostal chest drain, or call for help to do so, after successful emergency needle decompression.

Blood control (closed system) intravenous catheters must not be used to decompress a tension pneumothorax. These intravenous catheters contain an integral septum that closes when the needle is withdrawn, preventing air flow out of the pleural cavity.[28]

Contraindications

None if tension pneumothorax is diagnosed. This condition is life-threatening, and time is of the essence.

If the clinical history and examination findings are not suggestive of tension pneumothorax, seek an alternative diagnosis.

Indications

Needle decompression of the gas-filled pleural cavity is performed only when there is suspicion of a tension pneumothorax.

Complications

  • Iatrogenic pneumothorax

  • Hemothorax

  • Laceration of the lung

  • Failure to decompress

  • Kinking or blocking of the catheter and recurrence of the tension pneumothorax.

Aftercare

Reassess the patient after insertion of the catheter, using the observe, palpate, percuss, auscultate technique. In some cases, the needle decompression is insufficient to relieve the tension pneumothorax, and insertion of an intercostal tube is needed immediately to provide adequate relief.[29]

Some causes of needle decompression failure are:

  • Insufficient length of the catheter[30]

  • Obstruction (blood, tissue, kinking)[29]

  • Missing a localized tension pneumothorax[29]

  • Air leaks from the lung faster than it can drain through the catheter[30]

  • Requirement for repeated needle decompression.[29]

It is important to perform definitive treatment with an intercostal chest drain immediately after decompressing a tension pneumothorax.