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

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).

Subscribe to get full access to the Journal of Paramedic Practice

Thank you for vising the Journal of Paramedic Practice and reading our archive of expert clinical content. If you would like to read more from the only journal dedicated to those working in emergency care, you can start your subscription today for just £48.

CPD Focus

Reading the Journal of Paramedic Practice counts towards your professional development

Develop your career

We provide professional information dedicated to paramedics covering training, education and jobs

Stay informed

Get the latest clinical information to ensure you are aware of the latest think and best practice in paramedicne

Subscribe now

Already registered? - Sign in here

Keep up to date with Journal of Paramedic Practice!

Sign up to Journal of Paramedic Practice’s regular newsletters and keep up-to-date with the very latest clinical research and CPD we publish each month.