What is the name of the procedure used to decompress a tension pneumothorax with a needle?

Needle Thoracostomy for Tension Pneumothorax

The procedure used to decompress a tension pneumothorax with a needle is called needle thoracostomy or needle thoracentesis. 1 This emergency procedure is performed to convert a life-threatening tension pneumothorax into a simple pneumothorax by releasing the trapped air in the pleural space.

Procedure Details

Site Selection

• Primary site: 2nd intercostal space in the midclavicular line (2nd ICS-MCL)
  • Preferred for left-sided pneumothoraces due to lower risk of cardiac injury 1
• Alternative site: 5th intercostal space in the midaxillary line (5th ICS-MAL)
  • More suitable for right-sided pneumothoraces 1

Equipment Requirements

• Needle size: 14-gauge needle/angiocatheter 2, 1
• Needle length: Minimum 7 cm, ideally 8.25 cm (3.25 inches) 1
  • Standard 4.4-cm catheters fail in approximately 50% of trauma patients due to insufficient length 3, 4
  • Failure rates decrease by 7.76% per cm of increased needle length 1

Procedure Technique

1. Identify the proper insertion site (2nd ICS-MCL or 5th ICS-MAL)
2. Prepare the area with antiseptic solution
3. Insert the needle perpendicular to the chest wall, just above the rib (to avoid neurovascular bundle)
4. Advance until a rush of air is heard/felt, indicating entry into the pleural space
5. Remove the needle while leaving the catheter in place
6. If available, attach a one-way valve to prevent air re-entry 2
7. Leave the catheter in place until a definitive chest tube can be inserted 1

Monitoring and Follow-up

• Monitor the patient closely after needle thoracostomy
• Watch for recurrence of tension pneumothorax symptoms 2, 1
• If symptoms recur, repeat the procedure or proceed to tube thoracostomy (chest tube insertion) 2

Common Pitfalls and Complications

• Insufficient needle length: Most common cause of procedure failure 1, 3, 4
• Catheter dislodgment: Can lead to recurrence of tension pneumothorax 1
• Injury to underlying structures: Particularly with improper placement 1
• False negative results: Can occur if needle samples air from a bulla rather than the pleural space 5
• Unnecessary procedures: Studies show up to 39% of patients receiving needle thoracostomy may not have had a tension pneumothorax 6

Diagnostic Considerations

Tension pneumothorax presents with:

• Progressive dyspnea/respiratory distress
• Attenuated or absent breath sounds on the affected side
• Tachycardia, hypotension, and shock in severe cases 2, 1

Portable ultrasound can aid diagnosis with 92.0% sensitivity and 99.4% specificity 1, particularly valuable in noisy battlefield environments 2.

Remember that needle thoracostomy is a temporizing measure until definitive treatment with tube thoracostomy (chest tube placement) can be performed.