Equipment 8-252 - Decompression Needle

CMH EMS & MIH Protocols

Scope of Practice:

Registered Nurse
Paramedic

Indications:

Contraindications:

None in presence of tension pneumothorax.

Precautions:

Complications may include laceration of intercostals vessels, creation of pneumothorax, laceration of lung tissue, and risk of infection.

ARS / SPEAR Procedure:

Select site:

Fifth intercostal space on anterior axillary line OR
Second intercostal space on mid-clavicular line.

Cleanse site.
Remove red cap from case with twisting motion and remove needle from case.
Insert needle through skin targeting the rib below the level of intended insertion site.

Direct needle superiorly over rib and into thoracic cavity ensuring perpendicular position relative to thoracic cavity.
Ensure needle entry is not medial to nipple line and not directed toward heart.

Release catheter from needle by 1/4 turn and advance catheter. Remove needle only when catheter has been fully inserted.
If tension pneumothorax returns, repeat procedure.

Turkel Procedure:

Select site:

Fifth intercostal space on anterior axillary line OR
Second intercostal space on mid-clavicular line.

Clean area with antiseptic.
Insert Turkel into skin over just over superior border of third rib.
Insert catheter through paretal pleura until air escapes.
During insertion, the color band will show RED until through paretal pleura, and then it turns GREEN.
Advance catheter off device.
Air should exit under pressure.
Close 3-way valve.
Reassess frequently for redevelopment of pneumothorax.
If tension pneumothorax returns, open 3-way valve to release pressure.

Gelco Procedure:

Select site:

Fifth intercostal space on anterior axillary line OR
Second intercostal space on mid-clavicular line.

Clean area with antiseptic.
Insert Jelco into skin over just over superior border of third rib.
Insert catheter through paretal pleura until air escapes.
Air should exit under pressure.
Remove needle and leave plastic catheter in place.
Reassess frequently for redevelopment of pneumothorax.
If tension pneumothorax returns, repeat procedure.

Citations:

Protocol 9-010 - References
North American Rescue, 2018.

Change Log:

Date	Link to previous version	Description of change
12/29/14	pdf	Created this protocol from 8-380 (Thoracentesis) and 8-410 (Turkel Needle). Removed 8-380 and 8-410.
06/01/15	pdf	Added indication for Protocol 6-085 - High-Threat Response.
03/01/19	pdf	Added mid-axillary as the preferred site due to PHTLS ver 9 recommendations.
03/20/19		Added ARS procedure.
07/04/20		Renumbered the section to allow for future additions.
08/07/20	pdf	Added content (without substantive modification) from old Section 8-075 - Decompression Needle.
06/11/21	pdf	Moved to emsprotocols.online

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