What is the procedure for performing a finger thoracostomy (FT) in a case of suspected tension pneumothorax?

From the Guidelines

A finger thoracostomy is not the recommended initial procedure for suspected tension pneumothorax, instead, a cannula of adequate length should be promptly inserted into the second intercostal space in the mid-clavicular line. The procedure for managing a suspected tension pneumothorax involves inserting a cannula into the pleural space to rapidly decompress the tension pneumothorax 1.

Key Steps:

• The patient should be given high concentration oxygen
• A cannula should be introduced into the pleural space, usually in the second anterior intercostal space mid-clavicular line
• Air should be removed until the patient is no longer compromised
• Then an intercostal tube should be inserted into the pleural space

Important Considerations:

• The development of tension in a pneumothorax is not dependent on the size of the pneumothorax and the clinical scenario of tension pneumothorax may correlate poorly with chest radiographic findings 1
• The clinical status is striking, with the patient rapidly becoming distressed with rapid laboured respiration, cyanosis, sweating, and tachycardia 1
• Advanced Trauma Life Support guidelines recommend the use of a cannula 3–6 cm long to perform needle thoracocentesis for life-threatening tension pneumothorax, however, a cannula length of at least 4.5 cm should be used in needle thoracocentesis of tension pneumothoraces 1

From the Research

Procedure for Performing a Finger Thoracostomy

The procedure for performing a finger thoracostomy (FT) in a case of suspected tension pneumothorax involves several key steps:

• Insertion of the finger into the thoracic cavity to relieve pressure and allow air to escape
• The procedure is typically performed in emergency situations where other methods of decompression, such as needle thoracostomy, are not feasible or have failed 2
• FT is considered a more invasive procedure compared to needle thoracostomy, but it can be effective in relieving tension pneumothorax, especially in cases where the chest wall is too thick for needle decompression to be effective 3, 4

Indications and Considerations

The decision to perform a finger thoracostomy should be based on the patient's clinical presentation and the suspected presence of a tension pneumothorax:

• The procedure is typically indicated in cases of traumatic or spontaneous tension pneumothorax, where the patient is showing signs of respiratory distress and hemodynamic instability 5, 2
• The choice of procedure, whether FT or needle thoracostomy, depends on the patient's anatomy, the availability of equipment, and the provider's level of training and experience 6
• It is essential to consider the potential risks and complications associated with FT, including injury to underlying vital structures and the potential for infection 5, 2

Training and Experience

The performance of a finger thoracostomy requires specialized training and experience:

• Providers should be familiar with the anatomy of the thoracic cavity and the techniques for performing FT 6
• Regular training and practice are necessary to maintain proficiency in the procedure and to ensure that it is performed safely and effectively 5, 2
• The use of simulation models or other training aids can be helpful in teaching the procedure and in maintaining provider competency 6