Objectives: Recent research describes failed needle decompression in the anterior position. It has been hypothesized that a lateral approach may be more successful. The aim of this study was to identify the optimal site for needle decompression.Methods: A retrospective study was conducted of emergency department (ED) patients who underwent computed tomography (CT) of the chest as part of their evaluation for blunt trauma. A convenience sample of 159 patients was formed by reviewing consecutive scans of eligible patients. Six measurements from the skin surface to the pleural surface were made for each patient: anterior second intercostal space, lateral fourth intercostal space, and lateral fifth intercostal space on the left and right sides.Results: The distance from skin to pleura at the anterior second intercostal space averaged 46.3 mm on the right and 45.2 mm on the left. The distance at the midaxillary line in the fourth intercostal space was 63.7 mm on the right and 62

Emergency department (ED) patients routinely undergo placement of a saline lock device (SLD) with the aspiration of blood for laboratory testing. Drawing blood through a SLD may result in hemolysis of sample, repeated venipuncture and increased ED length of stay (LOS). The objective of this study was to examine if separate venipunctures for intravenous (IV) access and laboratory studies decrease the rate of hemolysis and ED LOS. The study was conducted at an urban university level 1 trauma center with an ED volume of 55,000. We compared the rate of hemolysis and ED LOS before and after mandating the use of separate venipunctures for IV access and laboratory studies over 1 month. Venipuncture was performed utilizing either a 21 ga needle or an IV catheter (BD Insight Autoguard) with a needless vacutainer. The incidence of hemolysis was calculated and a Student's t test was used to compare groups. The potassium sample redraw and processing time was observed. Blood was aspirated from 315 patients using the SLD. A baseline hemolysis rate of 23.0% (16.7-29.1) was obtained, corrected to 6.7% after factoring a 29.2% redraw rate for critical potassium levels. In the following month, 2,564 samples were obtained using the butterfly needle with a hemolysis rate of 6.6% (5.5-7.5), corrected to 2.0% after applying the 29.2% redraw rate. Avoiding hemolysis, we saved 4.7% of our patients' 56 min of ED stay, and avoided 185 retests over the month. In conclusion, venipuncture from a butterfly needle decreases the rate of hemolysis and may decrease the overall ED LOS.

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