- Equipment
- Large-bore cannula (at least 14G, preferably 10–12G, 8 cm in length in adults)
- Antiseptic solution
- Gloves, sterile gauze
- Patient position
- Supine or with head slightly elevated
- No time for full sterile prep in true emergency
- Site selection
- Traditional site: second intercostal space, midclavicular line on the affected side
- Alternative (increasingly preferred): fifth intercostal space, anterior or mid-axillary line — more reliable in larger or muscular patients
- Procedure
- Identify anatomical landmarks
- Clean the site quickly
- Insert the cannula just above the upper border of the rib to avoid the neurovascular bundle
- Use firm, steady pressure to puncture the skin, subcutaneous tissue, and parietal pleura
- You may feel a “pop” as you enter the pleural space
- Confirm success by:
- Sudden release of air (audible hiss)
- Improved clinical signs (oxygenation, heart rate, blood pressure)
- Advance the catheter fully and remove the needle
- Secure catheter in place
- Post-procedure
- This is a temporary measure
- Must be followed by definitive chest drain insertion as soon as possible