Determination of the appropriate catheter length and place for needle thoracostomy by using computed tomography scans of pneumothorax patients

Determination of the chest wall thicknesses and needle thoracostomy success rates at second and fifth intercostal spaces: a cadaver-based study

“…This rate is lower compared with other published studies (66.4%-94.3%) except 3 trials [8,11,13,15,17]. A recent meta-analysis, which also includes our prior CT-based trial [17], concluded that an optimally placed 5-cm-long catheter would have enough length to decompress 72% of the cases [24]. Therefore, we observed a higher (but not the highest) success rate compared with previous cadaver and imaging-based studies.…”

“…Various needle lengths and locations were proposed and fifth intercostal space (ICS) emerged as the most popular alternative. Because it is unethical and nearly impossible to perform a randomized controlled trial comparing the success and complication rates at second ICS mid-clavicular line (MCL) to fifth ICS MAL in TPX patients, secondary ways were sought, and imaging-based chest wall thickness (CWT) measurement has emerged [1,5,[7][8][9][10][11][12][13][14][15][16][17][18]. In those imaging-based studies, CWTs of the locations were compared with the length of typical needles (4.5, 5, and 6 cm) to estimate the success rate [9,19].…”

Needle decompression of tension pneumothorax

“…Based on smaller measurements of CWT, which may result in a potentially higher rate of successful needle decompression, some authors endorse the anterior approach, 18,21,23,26 while others endorse the lateral puncture site. 9,24,25,28 CONCLUSION Based on the population-based epidemiologic data presented in this study, the use of a needle of 7 cm in length is recommended to decompress a tension pneumothorax in the second intercostal space in the midclavicular line. When using this anterior approach at the anatomically correct puncture site, the safety margin to the internal mammary artery is sufficient so that the risk of iatrogenic lesions of the internal mammary artery should be minimal.…”

Needle thoracostomy for tension pneumothorax: the Israeli Defense Forces experience

“…This clinical success rate seems exceptionally high considering evidence suggesting that NT may fail to decompress TPTX in up to 50% of patients. [9][10][11][12]27 Furthermore, because a similar rate of clinical improvement was reported in patients surviving their injuries as in patients who did not survive, it seems that these high success rates are the result of inaccurate subjective assessment. In the present study, 32% of patients undergoing NT eventually had a CD installed in the prehospital setting, implying a true failure rate more consistent with that reported in the available literature.…”

“…[10][11][12] In other reports, techniques such as cadaver dissection 13,14 and ultrasonography 15,16 were used to detect the penetration of catheters. On the basis of these findings, a recommendation for change was issued, and many prehospital organizations have adopted the use of longer catheters.…”