Successful decompression is dependent on the needle reaching the thoracic cavity, the patency of the catheter, and the correct identification of the appropriate landmarks. Increasing chest wall thickness has led to recommendations to use longer angiocathetersto ensure successful access to the thoracic cavity.
Studies of both prehospital and hospital providers have demonstrated that though landmarks can be appropriately recited, they are not always accurately identified. Cadaver studies have shown improved success in reaching the thoracic cavity when the fourth or fifth intercostal space mid-axillary line is used instead of the second intercostal space mid-clavicular line in adult patients. ATLS now recommends this location for needle decompression in adult patients. Pediatric needle decompression is still recommended at the 2nd intercostal space in the mid-clavicular line.
Reference
- Inaba K, Branco BC, Eckstein M, et al. Optimal positioning for emergent needle thoracostomy: A cadaver-based study. J Trauma. 2011;71(5):1099-1103.
Emergency Physician at Lake Michigan Emergency Specialists - Core faculty member at West Michigan EM Residency - Michigan State University COM Clinical Faculty - Founder of Banana Bag Blog
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