This method allegedly reduces the risk of puncturing apex of pleura and causing pneumothorax.
(Usual pre-procedure steps and positioning)
– Place finger (A) in supra-clavicular notch at junction of medial 1/3 and lateral 2/3 of clavicle
– Entry point 1.5-2.0cm below junction of medial 2/3 and lateral 1/3 of clavicle
– Angle needle towards finger (A) just under clavicle, walking off if necessary. Often hit subclavian vein in this trajectory.
– If no puncture then systematically re-orientate needle towards supra-sternal notch in stepwise fashion.
This method should avoid breaching the pleura
– JB, GGH