Figure 3-6. Sites for needle decompression.
Always provide the optimum condition the situation allows. If there is time,
put on a mask and gown.
Prepare and drape the patient in this manner:
(a) For air removal, prepare the area over the second (or third)
intercostal space at the midclavicular line.
(b) For liquid removal, confirm the fluid level by the dullness to
percussion. Then, use the first or second intercostal space below the fluid level in the
posterior axillary line. DO NOT use lower than the eighth intercostal space.
Anesthetize the area locally if the patient is conscious or if time permits.
(7) Position the patient. You may position him in an upright position if you
have determined that he does not have a cervical spine fracture.
(8) Insert the thoracentesis needle (attached to a three-way cock and
syringe) into the skin. Direct the needle just over the rib into the intercostal space. DO
NOT leave the needle open to air.
Puncture the parietal pleural space.
(10) Aspirate as much air as necessary to relieve the patient's acute
(11) Leave the plastic catheter in place and apply a bandage or a small