Appendix 1: Needle thoracocentesis
- Identify the second intercostal space, using the manubrial-sternal junction as a landmark
- Clean the area and a surrounding margin
- Infiltrate local anaesthesia if time and the patient’s condition allow
- Insert a large bore cannula into the 2nd intercostal space, just above the 3rd rib to avoid the neurovascular bundle, which runs along the underside of each rib
- In large players the 5th intercostal space anterior to the mid-axillary line is preferred.
- Remove the needle, leaving the cannula in-situ. Listen for a sudden escape of air, which will indicate decompression of a tension pneumothorax
- Review and constantly monitor the patient’s condition and be prepared to repeat the procedure if necessary
2nd intercostal space mid clavicular line
5th Intercostal space anterior to the mid axillary line
Complications of Needle Thoracocentesis
- Failure of technique
- Local haematoma
- Lung laceration
- Creation of a pneumothorax if initial diagnosis was incorrect