Trick of the Trade #1:
If aiming for the mid-clavicular 2nd ICS, go more lateral than you think. The clavicle ends in the shoulder, not the lateral chest wall! (1)
Trick of the Trade #2:
Insert angiocatheter at the 5th ICS along the mid-axillary line, similar to the location of a chest tube.
Trick of the Trade #3:
Regardless of whether you use the mid-clavicular 2nd ICS or mid-axillary 5th ICS, use a longer angiocatheter than a traditional 3 cm IV angiocatheter. Otherwise it won't reach the pleural space!
Thanks to Dr. Scott Weingart ( @emcrit ). Listen to the podcast for more tips and suggestions on this topic at his EMCrit blog !