Open thoracostomy (sometimes referred to as finger thoracostomy) is an incision through the thoracic wall to decompress the pleural space in a patient with tension pneumothorax, or a patient who is hypoxaemic and/or hypotensive in whom pneumothorax cannot be excluded.

The procedure is the first step in the insertion of a thoracostomy tube (intercostal catheter), which should then be connected to a drainage system. However in patients undergoing positive pressure ventilation (ie. those who have been intubated), it is acceptable to limit the procedure to open thoracostomy in the prehospital phase, and delay intercostal catheter insertion until the patient is in hospital. This reduces the risk of misplaced tubes and the delays associated with securing the tube.

Sometimes during transport, such as inside a helicopter in flight, the soft tissues of the thoracic wall may re-appose resulting in temporary closure of the thoracostomy and reaccumulation of pneumothorax. In this case it may be necessary to intermittently re-finger the thoracostomy wound or splint the tissues open with a temporary solution such as tracheal tube or free-ended intercostal catheter (ie. not attached to a drainage system).

This video clarifies the indications:

 

This video shows how the procedure is performed: 

This blog post provides more information:

Resus.ME post on open thoracostomy

 

Further reading

Massarutti D, Trillò G, Berlot G, Tomasini A, Bacer B, D’Orlando L, et al.

Simple thoracostomy in prehospital trauma management is safe and effective: a 2-year experience by helicopter emergency medical crews.

European Journal of Emergency Medicine. 2006 Oct;13(5):276–80