title: Needle thoracocentesis in tension pneumothorax: insufficient cannula length and potential failure.
abstract: Advanced Trauma Life Support guidelines recommend the use of a cannula 3 to 6 cm long to perform needle thoracocentesis for life-threatening tension pneumothorax. The chest wall thickness in the 2nd intercostal space, mid-clavicular line, was determined by ultrasound in 54 patients aged 18 to 55 years, and ranged from 1.3 to 5.2 cm (mean 3.2 cm). In thirty-one patients (57 per cent) the chest-wall thickness (CWT) was greater than 3 cm, the minimum recommended cannula length, although in only two (4 per cent) was it greater than 4.5 cm, the length of cannula commonly used in the UK. As a 3 cm cannula would fail to reach the pleural cavity in over half of patients, we suggest that the recommended shortest length be increased to 4.5 cm. Unsuccessful needle thoracocentesis using a 4.5 cm cannula should be followed immediately by insertion of a longer cannula or a definitive chest drain.
authors.affiliation: Department of Orthopaedic Surgery, Royal United Hospital, Bath, UK.
authors.forename: S
authors.initials: S
authors.lastname: Britten
authors.forename: S H
authors.initials: SH
authors.lastname: Palmer
authors.forename: T M
authors.initials: TM
authors.lastname: Snow
mesh_terms: D000293:Adolescent; D000328:Adult; D015505:Chest Tubes; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000473:pathology / Q000601:surgery*; D013907:Thoracostomy / Q000295:instrumentation* / Q000379:methods; D017211:Treatment Failure