Should we consider the use of alternative sites for needle thoracostomy?

Ben Mays
Monday, May 2, 2016

In the absence of advanced practitioners on scene, needle thoracostomy (NT) is the only treatment modality currently widely available to paramedics in order to relieve tension pneumothorax. Both ATLS and JRCALC guidelines (Association of Ambulance Chief Executives, 2013) recommend that for NT, a cannula be placed at the second intercostal space at the mid-clavicular line (ICS2-MCL). This paper, however, cites a number of difficulties associated with NT at this site, namely, variable chest wall thickness (CWT) and inability of practitioners to identify the correct anatomical location. Commonly used alternative sites consist of the 4th/5th intercostal space, mid axillary line (ICS4/5-MAL) and 4th/5th intercostal space, anterior axillary line (ICS 4/5-AAL).

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