Needle Decompression - Are we Teaching the Right Location?
Tension pneumothorax frequently results in circulatory collapse and may lead to cardiopulmonary arrest.
In the event that tube thoracostomy cannot be immediately performed, traditional teaching is to perform needle decompression in the second intercostal space, mid-clavicular line using a 5-cm angiocath needle.
Recent literature, however, has challenged the traditional location for needle decompression. In fact, researchers found:
Needles placed in the second intercostal space often failed to enter the chest cavity and relieve tension physiology.
Needles placed in the fifth intercostal space in the anterior axillary line were more likely to enter the chest cavity with a lower failure rate.
Take Home Point: It may be time to reconsider the optimal position for needle decompression of tension pneumothorax.
References
Inaba K, et al. Optimal positioning for emergent needle thoracostomy: A cadaver-based study. J Trauma 2011; 71:1099-1103.
Inaba K, et al. Radiologic evaluation of alternative sites for needle decompression of tension pneumothorax. Arch Surg 2012; 147:813-8.
Martin M, et al. Does needle decompression provide adequate and effective decompression of tension pneumothorax? J Trauma 2012; 73:1412-1417.
