Evaluation of the Optimal Site and Needle Length of Needle Thoracostomy
in Chest Trauma Patients

Kong, Mingyu; Kim, Hyunjong; Park, Junseok; Kim, Kyung Hwan; Shin, Dongwun; Kim, Hoon; Park, Joon Min; Jeon, Woochan

J Korean Soc Emerg Med > Volume 27(5); 2016 > Article

Original Article

Journal of The Korean Society of Emergency Medicine 2016;27(5): 396-403.

흉부 외상 환자를 대상으로 한 바늘흉강감압술 도관의 길이 및 삽입 위치에 대한 연구

공민규, 김현종, 박준석, 김경환, 신동운, 김 훈, 박준민, 전우찬

인제대학교 일산백병원 응급의학과

Evaluation of the Optimal Site and Needle Length of Needle Thoracostomy in Chest Trauma Patients

Mingyu Kong, Hyunjong Kim, Junseok Park, Kyung Hwan Kim, Dongwun Shin, Hoon Kim, Joon Min Park, Woochan Jeon

Department of Emergency Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea

Correspondence

Hyunjong Kim ,Tel: 031-910-7944, Fax: 031-910-7188, Email: drkim@paik.ac.kr,

Received: June 15, 2016; Revised: June 16, 2016 Accepted: July 15, 2016. Published online: October 30, 2016.

ABSTRACT

Purpose:
Tension pneumothorax is a life threatening condition. As an emergency treatment, needle thoracostomy with 50mm angiocatheter at the second intercostal space on the mid-clavicular line (2^nd ICS/MCL) is recommended in the current guidelines. However, another site has been suggested in some studies. The purpose of this study was to determine whether the current procedure should be changed, by comparing the chest wall thicknesses (CWT) at the 2^nd ICS/MCL and the 5^th ICS/AAL (anterior axillary line) of injured patients.
Method:
A retrospective observational study was performed in an emergency center between May 2009 and December 2011. Medical records and computed tomography (CT) images of 140 included patients were reviewed. CWT at the 2^nd ICS/MCL was compared with the 5^th ICS/AAL. Moreover, the relationship between BMI (body mass index) and CWT was evaluated.
Results:
CWT of the 2^nd ICS/MCL was 31.7±8.5 mm on the right and 31.6±8.8 mm on the left, with no differences (p=0.42). CWT of the 5^th ICS/AAL was 28.1±8.5 mm on the right and 27.8±7.7 mm on the left, also with no differences (p=0.30). CWT of the 2^nd ICS/MCL was thicker than that of the 5^th ICS/AAL (p<0.001). Nevertheless, CWT of all sites were not thicker than 50 mm (p<0.001). BMI was positively correlated with CWT.
Conclusion:
There was insufficient amount of evidences shown in this study to change the current guidelines of needle thoracostomy. However, in case of obvious patients, a long needle and 5^th ICS/AAL site should be considered for needle thoracostomy, because CWT tended to increase as BMI increased.

Key words: Chest injury, Needle thoracostomy, Tension pneumothorax