Wednesday November 2, 2005
Regarding Needle Thoracostomy
Needle thoracostomy continue to be one of the life saving procedures in ICUs for tension pneumothorax. But recent literature and anecdotal reports suggest that needle thoracostomy should be perform only in situations where severe hemodynamic compromise is imminent or diagnosis of pneumothorax is very clear. It is not a benign procedure as thought and should not be taken lightly. Blind needle thoracostomy carries good risk of lung laceration and air embolism through such a laceration is a real concern. If possible, its better to wait for radiological confirmation and perform chest tube placement in more controlled enviroment.
Another point raised in recent literature is regarding length of the needle. Standard 5 cm long needle has been found to fail 25% of the procedures. (14-16 G IV cannula is preferred). If thick chest wall presumed, 6 cm long needle has been recommended.
Refrences: click on link to get article/abstract
1. Needle Thoracostomy - Archive of debate at trauma.org
2. image of procedure site - Deptt. of Anesth. & inten. care, Chinese Univ. of Hong Kong
3 Needle Thoracostomy: Implications of Computed Tomography Chest Wall Thickness - Acad Emerg Med Volume 11, Number 2 211-213
4. Needle Thoracostomy in Trauma Patients: What Catheter Length Is Adequate? - Acad Emerg Med Volume 10, Number 5 495.