Tension pneumothorax is a medical emergency requiring immediate intervention. Needle decompression is a quick and temporary measure to relieve pressure before definitive chest tube placement.

Indications

• Severe respiratory distress

• Absent breath sounds on one side

• Tracheal deviation (late sign)

• Hypotension & JVD (signs of obstructive shock)

Procedure Steps

1️⃣ Assess – Confirm signs of tension pneumothorax.

2️⃣ Oxygen – Provide high-flow O₂, assist ventilation.

3️⃣ Identify the Site –

• Adults: 4th/5th ICS, anterior to midaxillary line

• Pediatrics: 2nd ICS, midclavicular line

4️⃣ Prep & Anesthetize – Clean the site, anesthetize if possible.

5️⃣ Insert Needle – Use a 3-inch (8 cm) over-the-needle catheter with a 10 cc syringe. Insert just above the rib, aspirating for air.

6️⃣ Puncture Pleura – Confirm air release.

7️⃣ Advance Catheter – Remove the needle, leaving the catheter in place.

8️⃣ Secure & Monitor – Stabilize the catheter and prepare for chest tube insertion.

Key Points

✅ Use large-bore (14-16G) catheter for adults.

✅ Needle decompression is temporary—always follow with chest tube placement.

✅ If no improvement, consider malposition or blockage and reassess.

This simple but critical procedure can prevent cardiac arrest—act fast! 🚑