Don’t Treat Kids as Tiny Adults in Needle Thoracostomy
Pediatric needle thoracostomy is a rarely performed procedure, but one must know the technique and be prepared to perform it. It can be life-saving in the face of a tension pneumothorax. This is a simple procedure, but a few procedural fine points can guarantee success and safety.Adult Needle ThoracostomyWe have learned only relatively recently that most adult needle thoracostomies fail to accomplish their mission. A 5 cm angiocatheter inserted at the second intercostal space on the midclavicular line has been the Advanced Trauma Life Support guidelines recommendation for at least a decade. Unfortunately, we now know that our needle thoracostomies are frequently not reaching the pleural cavity. The second intercostal space on the midclavicular line has been the classic location recommended, but growing evidence shows that it is probably the least successful of all locations for a successful needle thoracostomy.A 2013 retrospective review of the CT scans of 201 patients found that the average chest wall thickness in the overall cohort was 4.08 cm at the second intercostal space on the midclavicular line and 4.55 cm at the fifth intercostal space on the anterior axillary line. (Injury. 2013;44:1183.) Twenty-nine percent (27 men and 32 women) had a chest wall thickness greater than 4.5 cm at the second intercostal space on the midclavicular line, and 45 percent (54 men and 36 women) had a chest wall thicker than 4.5 cm at the fifth intercostal space at the anterior axi...
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