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PERFORM SIMPLE FINGER THORACOSTOMY
1. Position the casualty on their back and raise the arm on the affected side above the casualty’s
head.
2. Mark the insertion site at the mid-axillary line over the 4th or 5th intercostal space.
3. Cleanse the site with an antiseptic solution
4. Liberally infiltrate the area with 2% lidocaine solution
5. Make a 2–3cm transverse incision on the marked site (The incision should be a 2–3cm trans-
verse incision over the selected site and extend down to the intercostal muscles and 1–2cm
below the interspace through which the tube will be placed)
6. Use a finger to widen the tract, confirming access to the intercostal space
Note: Identify the rib below the insertion site to find the pleural space above the rib
7. Perforate the pleura by advancing a blunt instrument, such as a hemostat
Note: Hold the forceps with two fingers, curved side down, ½ inch from the tip. The fingers
will be used to prevent the forceps from going too far into the pleural space
8. Spread the hemostat clamps, forcing the tissue apart
9. Perform a finger sweep to ensure access to the pleural space
Note: You may not be able to palpate the lung parenchyma and detect lung inflation/deflation if the
casualty is receiving positive pressure ventilation.
10. Assess the release of air and/or blood
11. Apply a vented chest seal to complete a finger thoracostomy
**Document procedure, results, and vital signs.**

VASCULAR ACCESS (INTRAVENOUS)
Clinical Indications
• Need for intravascular access to provide resuscitative fluids and/or medications
• Anticipated need for intravenous access in emergency patients
Contraindications
• Injuries proximal to IV site/ipsilateral to IV site (relative)
Procedure
• Prepare all necessary equipment: PPE, tourniquet, IV catheters, alcohol/betadine wipe, saline lock or
IV tubing, IVFs if administering, and tape/securing device.
• Ensure all IV tubing/saline locks are flushed prior to attempting IV
• Place a venous tourniquet proximal to the anticipated IV puncture site
• Identify the vein to be cannulated and cleanse the overlying area with alcohol/betadine
• While holding traction on skin/vessel, cannulate the vessel (use a shallow angle of attack with the
needle). Once the flash returned, advance slightly to ensure the catheter is in the vessel, then advance
the catheter fully into the vessel (should pass without resistance)
• While holding pressure proximally on the vein and maintaining catheter position, remove the
tourniquet and needle. Attach NS flush and flush IV—this fluid should flow easily into the vein—any
resistance suggests a missed attempt or “blown” vein.
[Note: If blood samples are being drawn, they should be taken prior to removing the tourniquet and
always prior to flushing (after flushing, a dilute sample may be obtained, which will alter results)]
• Secure the catheter using a transparent dressing or tape
• Repeat until 2 IV sites have been established and are functional
**Document procedure, results, and vital signs.**

204 • PROCEDURES