Figure 3-7. Needle position on the mid-clavicular line above the third rib.
Prepare the area with anti-microbial scrub if time permits.
(4) Insert the needle point at a 90 degree angle over the top of the third rib
into the second intercostal space (figure 3-8). Stop advancing the needle once a hiss
of air is heard. You should feel a "pop" as the needle enters the chest cavity or you
aspirate air (if using a syringe/needle combination).
Over insertion of the needle can cause damage to underlying lung tissue or
other vital organs. Care must be taken not to over insert the needle.
Hold the catheter in place and remove the needle. Safely dispose of
(6) Tape the catheter in place and monitor the casualty. The catheter can
be left in place as needed and flushed with saline every two hours to ensure patency.
If the mission dictates, it may be advisable to remove the catheter and then monitor
the patient closely for signs of building tension and then "re-needle" the chest if
necessary. REMEMBER: Once the patient develops a tension pnuemothorax, he will
continue to develop tension until the patient receives a chest tube. The patient must
be monitored closely.