Elsevier

Injury

Volume 32, Issue 10, December 2001, Pages 749-752
Injury

Needle thoracostomy may not be indicated in the trauma patient

https://doi.org/10.1016/S0020-1383(01)00082-1Get rights and content

Abstract

Objective: The aim of this study was to evaluate the usefulness of needle thoracostomy catheter (NTC) placement in trauma.

Methods: A consecutive case series was conducted from November 1996 to September 1997. All patients admitted to a level I trauma centre who had NTCs placed prior to arrival in the Emergency Department were included. No patients were excluded or omitted. During the course of the study 2801 patients were admitted to our trauma centre. Nineteen patients (0.68%) had NTCs placed prior to arrival in the emergency department.

Results: Twenty-five needle thoracostomies were performed in 19 patients. This group represented 0.68% of the trauma admissions. Four patients were found to have evidence of a pneumothorax with an air leak (28%). The NTC failed to decompress the chest in one of two patients who had physiologic evidence of a tension pneumothorax. Eleven patients (58%) were endotracheally intubated prior to NTC.

Conclusions: This study suggests that field NTC placements are often ineffective and may be over-used. Further study on the usefulness of NTC is required.

Introduction

Prehospital needle thoracostomy catheter (NTC) placement is considered a potentially life-saving procedure, and has been routinely used by our prehospital personnel in cases of suspected tension pneumothorax. The procedure involves the placement of a 14-gauge intravenous catheter needle at the second interspace in the mid-clavicular line. The needle catheter is passed into the pleural space and should then relieve the tension pneumothorax. The procedure is described in the literature as being both diagnostic and therapeutic. Several cases of insufficient cannula length, misplaced catheters and catheters of insufficient diameter to relieve a tension pneumothorax have been reported [1], [2], [3]. At our institution, the placement of needle thoracostomy catheters in patients who did not appear to have a tension pneumothorax prompted us to evaluate the use of NTC placement by the regional prehospital personnel.

Section snippets

Materials and methods

The Institutional Review Board exempted this study from requiring approval due to its observational nature. All patients admitted to the Emergency Department from November 1996 to September 1997 with prehospital NTC were prospectively identified and evaluated. Criteria examined in these patients included: mechanism of injury, vital signs during transport (and on arrival in the Emergency Department), oxygen saturation, endotracheal intubation, signs of tension physiology (distended neck veins,

Results

Twenty-five NTCs were placed in 19 patients admitted during the study period. Six patients had bilateral NTCs (32%). The 19 patients represented 0.68% of total trauma admissions (2801) during the 9 months of the study. Fourteen of the patients were victims of blunt trauma; five were victims of penetrating trauma. Five of the patients were admitted while undergoing cardiopulmonary resuscitation, all died. All 14 patients arriving in the Emergency Department with signs of life survived to

Discussion

Tension pneumothorax occurs when intrapleural pressure exceeds atmospheric pressure throughout expiration. A communication between the lung parenchyma and the pleural space acts as a one way valve, allowing air to enter the pleural space during inspiration but preventing its egress during expiration [4]. Needle thoracostomy placement at the second intercostal space has been suggested as a temporary measure until definitive thoracostomy tube placement [5]. The NTC converts the tension

Summary

In our catchment area, it does not appear that NTCs are performed exclusively for tension pneumothorax. The benefit of prehospital NTC decompression is questionable. NTC placement should be limited to patients with a clear suggestion of tension pneumothorax, rather than simply ‘decreased breath sounds’. Further investigation as to the role of NTC decompression of the chest is warranted.

References (10)

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No grants or funding has been accepted for this study. Presented at the 29th Annual Meeting of the Western Trauma Association February 1998 in Lake Louise, Alberta Canada

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