Emergency Medicine

NEEDLE THORACENTESIS

Practical Procedures 471

COMPLICATIONS

1 Failure, with malposition outside trachea.

2 Haemorrhage.

3 Trachea l tea r.

4 Mediastinal emphysema or pneumothorax.

5 Dysphonia/hoarseness.

NEEDLE THORACENTESIS

INDICATIONS

1 Therapeutic:
(i) Tension pneumothorax.
(ii) Aspiration of pneumothorax.
(iii) Aspiration of an effusion.

2 Diagnostic:
(i) Determine cause of pleural effusion.

CONTRAINDICATIONS

1 Uncooperative patient.

2 Uncorrected bleeding diathesis (in particular platelets <50 or international
normalized ratio [INR] >1.5).

3 Local skin infection.

4 Bu l lous lu ng d isease, sma l l ef f usion or sing le f u nct ioning lu ng (specia l ca re).

TECHNIQUE

1 Therapeutic tap (air)
(i) Lie the patient on a bed at 45° and infiltrate local anaesthetic
down to the pleura in the second intercostal space in the mid-
clavicular line.
(ii) Insert a 16-gauge cannula along the anaesthetized track into the
pleural cavity, bevel up, at 90° to the surface of the skin, working
‘just above the rib below’
(a) alternatively use a proprietary chest aspiration kit, with
special fenestrated cannula and one-way valve.
(iii) Withdraw the needle, and connect to a 50 mL syringe with three-
way tap.
(iv) Aspirate air until resistance is felt, the patient coughs excessively,
or >2500 mL is aspirated.