NEEDLE THORACENTESIS IN TENSION PNEUMOTHORAX - INSUFFICIENT CANNULA LENGTH AND POTENTIAL FAILURE

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 patien ts aged 18 to 55 years, and ranged from 1.3 to 5.2 cm (mean 3.2 cm). I n thirty-one patients (57 per cent) the chest-wall thickness (CWT) was greater than 3 cm, the minimum recommended cannula length, although i n only two (4 per cent) was it greater than 4.5 cm, the length of cann ula 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 recommen ded shortest length be increased to 4.5 cm. Unsuccessful needle thorac ocentesis using a 4.5 cm cannula should be followed immediately by ins ertion of a longer cannula or a definitive chest drain. (C) 1996 Elsev ier Science Ltd.