Page 383 - ATP-P 11th Ed

iii. Allow a conscious MWD to assume the ‘position of comfort’ (often the canine
will elect to sit or stand). If unconscious, place in the recovery (sternal) position
or lateral recumbency, placing the injured/affected side facing up.
iv. Use a 10 to 14-gauge, 2 to 3.25 inch (5–8cm) over-the- needle/catheter unit.
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v. Insert in the 7 to 9 intercostal space midway up the lateral thoracic wall or at
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the junctions of the upper 1/3 and lower 2/3 of the thoracic wall.
vi. Drawing a line from the point of the shoulder (greater tubercle of the proximal
humerus) to the distal tip of the last rib, defines the appropriate landmark for a
chest-NDC in a MWD.
NOTE: Canines have 13 ribs, the first 12 ribs are attached to the sternum via carti-
laginous extensions and the 13th rib “floats” free of sternal attachment. In compari-
son, humans have 12 ribs.
Ensure that the needle enters cranially (towards the head) of the rib.
i. The intercostal artery, vein, and nerve run on the caudal aspect (behind or to-
wards the tail) of each rib. Therefore, similar to the technique in human casual-
ties, the best approach for inserting chest-NDC device is in the center of the
intercostal space or at the cranial aspect (towards the head) of the rib to avoid
damaging the nerve and vascular structures.
ii. Insert the needle/catheter unit perpendicular to the chest wall.
iii. Insert the needle/catheter unit together until the needle can be felt entering the
pleural space. Two distinct “pops” will be felt through the needle–the first will
be felt as the needle/catheter unit passes through the skin and the second will be
felt when the needle penetrates the pleural cavity (this occurs when the catheter
is inserted to ½-¾ of its length). As the needle enters the pleural space, direct SECTION 4
the needle/catheter unit ventral (towards the sternum) to allow the needle/cath-
eter unit to lie parallel along the long axis of the internal thoracic wall as it is
inserted to the hub; this mitigates any risk of inducing lung or cardiovascular
trauma when inserting the needle/catheter unit to the hub.
NOTE: Because of conformational differences, MWDs will have a shorter distance
between their skin and the lateral thoracic wall (similar to the anterior axillary chest
NDC site in humans); therefore, “hubbing” a 3.25 inch or longer catheter is typi-
cally not necessary in an MWD and may cause damage to intrathoracic structures
if performed incorrectly.
iv. Ensure the bevel of the needle faces away from the inner thoracic wall and
towards to the lungs.
v. Hold the needle/catheter unit in placed for at least 5–10 seconds to allow full
decompression to occur.
vi. Once air is evacuated, remove the needle stylet. Consider leaving the catheter in
place to alert subsequent care providers that the MWD has received treatment
for a suspected tension pneumothorax.

ATP-P Handbook 11th Edition 373