Needle Decompression

ALS

 

  1. Auscultate the chest to confirm which side has a suspected tension pneumothorax (indicated by absence/decrease in breath sounds, hypotension, and significant respiratory distress)
  2.  

  3. Locate the second intercostal space at the midclavicular line.
  4.  

  5. Clean the skin.
  6.  

  7. For adults, insert a 3.25” 14-gauge needle over the superior border of the 3rd rib perpendicular to the floor/cot and with the bevel pointing toward the midline. Do not insert needle medial to the nipple line. For pediatric patients, use a 14- or 16-gauge needle that is no longer than 1.5 inches in length. 
  8.  

    When the needle reaches the visceral pleura, you may feel a “pop” and/or air may rush out

     

  9. An alternative needle decompression location may be authorized by the agency’s medical director.
  10.  

  11. Reassess and re-auscultate for improvement of breath sounds, pulse, respirations, and blood pressure.
  12.  

  13. Remove the needle and tape the catheter in place.
  14.  

  15. Reassess and re-auscultate for improvement of breath sounds, pulse, respirations, and blood pressure.

 

Complications

 

    Hemorrhage from laceration of intercostal vessels
    Hemorrhage from laceration of a pulmonary vessel
    Puncture of the lung

 

If needle decompression is attempted, a copy of the run record must be made available to the Medical Director through the CQI Coordinator within 24 hours of the run.