INTRODUCTION

Pleural decompression should be performed only when a tension pneumothorax is believed to be rapidly developing or already exists. Refer to the General Trauma and Mulit-System Trauma protocols.

1. Choose a catheter for decompression. Should be at least 14g 1.25" (2 1/4" Length Preferred)

2. Choose location for insertion:
   1. Preferred: Midclavicular line, 2nd intercostal space.
   2. Alternate: Anterior axillary line, 4th intercostal space.

3. Insertion
   1. Pull slight traction on the skin at the location of the insertion.
   2. Palpate the rib inferior to the intercostal space, which will have the needle inserted through.
   3. Insert the needle with a 90 deg angle to the skin on the superior margin of the inferior rib.
   4. Once contact is made with the rib's margin, 'walk' the needle over the superior margin of the costal and penetrate into the pleural space.
   5. Attach a one-way valve to the catheter.

4. Medical Control
   1. If time and the patient's condition allow, obtain medical control permission to perform this procedure since the complication of incorrect diagnosis may be a pneumothorax.

1. The purpose of pulling traction on the skin in the area of needle insertion is to create a mechanism by which the skin will self seal the thoracic cavity once the catheter is removed.
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