Tuohy Needle Use Process

Tuohy needle use process

Prepare the skin using sterile technique and lift the skin mass with local anesthetic through a 22- to 25-gauge needle. The Tuohy needle is then introduced vertically with the bevel facing the surface. It "walks away" from the upper border of the ribs and advances to just past the posterior intercostal membrane or between the parietal and visceral pleural cavities. When the needle penetrates the posterior intercostal membrane, the first position is usually indicated by a "pop" sound, and the pleural cavity can be identified by a resistance loss technique similar to epidural anesthesia. Pleural pressure always maintains a negative pressure breathing cycle, while intercostal pressure oscillates from negative to positive at end-inspiration and end-expiration, respectively. Spontaneous ventilation should be maintained during surgery. Controlled ventilation increases the risk of tension pneumothorax during positive pressure ventilation.

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