Where is the needle for a needle thoracostomy (NCD) inserted?

• A. Second intercostal space on the midclavicular line, directly over the top of the third rib
• B. Fourth intercostal space at the anterior axillary line
• C. Second intercostal space at the anterior axillary line
• D. Fifth intercostal space at the midclavicular line

Answer: (A)

Relief of a tension pneumothorax requires fast access to the pleural space with a large-bore needle. The go-to entry is the second intercostal space along the midclavicular line, and the needle is placed just above the superior border of the third rib. This placement lets air escape quickly while avoiding the intercostal vessels and nerve that run along the inferior edge of each rib. Other sites either don’t reach the space as reliably or pose more risk, so this specific location is preferred for needle thoracostomy.