Finger Thoracostomy: A Common Practice for Emergency Chest Decompression

Written By John Aho

By Johnathon M. E. Aho, MD, PhD

In emergency medicine, rapid and effective intervention can mean the difference between life and death. One such critical procedure is the finger thoracostomy (FT), an alternative to needle thoracostomy (NT) for decompressing tension pneumothorax. This method offers direct tactile confirmation of pleural space entry, potentially increasing the success rate in emergent situations.

What is Finger Thoracostomy?

Finger thoracostomy involves creating an opening in the chest wall to access the pleural space directly. Unlike needle thoracostomy, which relies on a catheter, this technique allows the practitioner to use their finger to confirm entry into the pleural cavity, ensuring effective decompression.

A recent Israeli case series(1) highlights several considerations to employing finger thoracostomy:

  • Increased Procedural Risks: FT is associated with higher risks of complications, including bleeding, infection, and inadvertent injury to internal structures, especially when performed by providers lacking surgical training.

  • Lack of Robust Evidence: The authors highlight a scarcity of high-quality studies supporting the superiority of FT over NT in prehospital settings. Much of the existing literature is based on limited case series or retrospective analyses, which may not provide conclusive evidence.

  • Training and Skill Requirements: FT necessitates a higher level of procedural expertise and anatomical knowledge compared to NT. The complexity of the procedure may lead to increased error rates among less experienced providers.

  • Operational Challenges: Implementing FT in the field may be hindered by factors such as limited equipment availability, environmental constraints, and the need for rapid decision-making under pressure.

Finger thoracostomy, while often more definitive than needle thoracostomy, does come with several downsides when compared to the needle approach:

More Invasive

  • Requires a surgical incision and blunt dissection through muscle and pleura.

  • Higher risk of bleeding, soft tissue damage, and pain.

Takes More Time

  • Slower to perform than a quick needle decompression, which can be critical in time-sensitive scenarios.

Requires More Equipment

  • Needs a scalpel, forceps/clamps, gloves, antiseptic, and often a chest tube setup afterward.

  • Not as feasible in prehospital or austere environments without full kits.

Greater Operator Skill Needed

  • Requires knowledge of anatomy, surgical technique, and sterile handling.

  • Mistakes (like misplacement or inadequate pleural entry) can be serious.

Not Ideal for Awake or Unsedated Patients

  • Much more painful than needle decompression.

  • Local anesthetic may not be feasible during emergency resuscitation.

Risk of Infection

  • Larger incision increases the risk of introducing infection into the chest cavity, especially if aseptic technique is compromised.

Why Use Capnospot?

Using a Capnospot Pneumothorax Decompression Indicator in conjunction with a NT will increase the speed and accuracy of thoracostomy and provide several additional benefits, including therapeutic and financial advantages.

The Capnospot attaches to any standard needle angiocatheter with a Luer lock fitting. As decompressed pneumothorax gas flows through the needle and Capnospot device, dark blue colorimetric paper turns bright yellow in seconds as it comes into contact with CO2. The color change provides visual confirmation of correct needle placement, allowing providers to quickly proceed with other relevant life-saving therapies. This is a quick, less invasive, more accurate and may be overall safer method that helps potentially decrease mortality rates.

Capnospot Benefits

  • Rapid, efficient and visual indication of correct needle placement

  • Easy to read results removes operator subjectivity, even in low lighting

  • Lightweight, portable, real-time confirmatory color change (from dark blue to yellow)

  • Compatible with existing decompression devices, catheters, and needles

  • Requires less equipment than basic finger thoracostomy (cost effective)

  • More accurate than listening for a gush of air

  • Built in one-way valve

  • Cost effective solution reduces the need for multiple needles to ensure success

  • Made in the United States

(1) “Finger thoracostomy: Significant risks and unproven benefits in prehospital settings” by Yael Mozer-Glassberg, Irina Radomislensky, Avi Benov, and Ofer Almog. Epub 2025 Mar 25. https://pubmed.ncbi.nlm.nih.gov/40134132/



John Aho