Needle thoracostomy: Clinical effectiveness is improved using a longer angiocatheter

Johnathon M. Aho, Cornelius A. Thiels, Moustafa M. El Khatib, Daniel S. Ubl, Danuel V. Laan, Kathleen S. Berns, Elizabeth B Habermann, Scott P. Zietlow, Martin D. Zielinski

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17 Scopus citations

Abstract

Background Decompression of tension physiology may be lifesaving, but significant doubts remain regarding ideal needle thoracostomy (NT) catheter length in the treatment of tension physiology. We aimed to demonstrate increased clinical effectiveness of longer NT angiocatheter (8 cm) compared with current Advanced Trauma Life Support recommendations of 5-cm NT length. Methods This is a retrospective review of all adult trauma patients from 2003 to 2013 (age > 15 years) transported to a Level I trauma center. Patients underwent NT at the second intercostal space midclavicular line, either at the scene of injury, during transport (prehospital), or during initial hospital trauma resuscitation. Before March 2011, both prehospital and hospital trauma team NT equipment routinely had a 5-cm angiocatheter available. After March 2011, prehospital providers were provided an 8-cm angiocatheter. Effectiveness was defined as documented clinical improvement in respiratory, cardiovascular, or general clinical condition. Results There were 91 NTs performed on 70 patients (21 bilateral placements) either in the field (prehospital, n = 41) or as part of resuscitation in the hospital (hospital, n = 29). Effectiveness of NT was 48% until March 2011 (n = 24). NT effectiveness was significantly higher in the prehospital setting than in the hospital (68.3% success rate vs. 20.7%, p <0.01). Patients who underwent NT using 8 cm compared with 5 cm were significantly more effective (83% vs. 41%, respectively, p = 0.01). No complications of NT were identified in either group. Conclusion Eight-centimeter angiocatheters are more effective at chest decompression compared with currently recommended 5 cm at the second intercostal space midclavicular line. Level of Evidence Therapeutic study, level IV.

Original languageEnglish (US)
Pages (from-to)272-277
Number of pages6
JournalJournal of Trauma and Acute Care Surgery
Volume80
Issue number2
DOIs
StatePublished - Feb 1 2016

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Keywords

  • intercostal chest drain
  • needle decompression
  • Needle thoracostomy
  • tension pneumothorax

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

Aho, J. M., Thiels, C. A., El Khatib, M. M., Ubl, D. S., Laan, D. V., Berns, K. S., Habermann, E. B., Zietlow, S. P., & Zielinski, M. D. (2016). Needle thoracostomy: Clinical effectiveness is improved using a longer angiocatheter. Journal of Trauma and Acute Care Surgery, 80(2), 272-277. https://doi.org/10.1097/TA.0000000000000889