Pleural Decompression

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Section 9 - Procedure Guidelines



  • Chest decompression for relief of tension pneumothorax.


  • 14 gauge 2 - 2.5 inch catheter over the needle.
  • Sterile glove finger.
  • Thread the #14 gauge catheter through the end of the glove finger from the inside.
  • Tape.
  • Sterile gauze pads.
  • Antiseptic swabs.
  • Occlusive dressing.


  • Locate decompression site.
    • Identify the 2nd intercostal space in the mid-clavicular line on the same side as the pneumothorax. OR
    • Identify the 5th intercostal space in the mid-axillary line on the same side as the pneumothorax.
  • Prepare the site with an antiseptic swab:
  • Firmly introduce catheter immediately above the distal rib of the site selected with a glove finger placed over the needle and catheter to serve as a flutter valve.
  • Insert the catheter through the parietal pleura until air exits. It should exit under pressure.
  • Advance catheter and remove needle.
  • Secure the catheter taking care not to allow it to kink.
  • Reassess lung sounds and patient condition.
  • Dress area with Occlusive dressing then cover with sterile gauze pad.
  • Flutter valve must be outside dressing and unobstructed.
  • Assess breath sounds and respiratory status.