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Sufficient Catheter Length for Pneumothorax Needle Decompression: A Meta-Analysis

Published online by Cambridge University Press:  10 April 2015

Brian M. Clemency ,
Christopher T. Tanski ,
Michael Rosenberg ,
Paul R. May ,
Joseph D. Consiglio  and
Heather A. Lindstrom
Brian M. Clemency*
Affiliation:
University at Buffalo, Department of Emergency Medicine, Buffalo, New YorkUSA
Christopher T. Tanski
Affiliation:
State University of New York Upstate Medical University, Department of Emergency Medicine, SyracuseNew YorkUSA
Michael Rosenberg
Affiliation:
University at Albany, School of Public Health, Albany, New YorkUSA
Paul R. May
Affiliation:
University at Buffalo, Department of Emergency Medicine, Buffalo, New YorkUSA
Joseph D. Consiglio
Affiliation:
John Carroll University, Department of Mathematics and Computer Science, Cleveland, OhioUSA
Heather A. Lindstrom
Affiliation:
University at Buffalo, Department of Emergency Medicine, Buffalo, New YorkUSA
*
Correspondence: Brian M. Clemency, DO Department of Emergency Medicine Erie County Medical Center 462 Grider St. Buffalo, New York 14215 USA E-mail: bc34@buffalo.edu
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Abstract

Introduction

Needle thoracostomy is the prehospital treatment for tension pneumothorax. Sufficient catheter length is necessary for procedural success. The authors of this study determined minimum catheter length needed for procedural success on a percentile basis.

Methods

A meta-analysis of existing studies was conducted. A Medline search was performed using the search terms: needle decompression, needle thoracentesis, chest decompression, pneumothorax decompression, needle thoracostomy, and tension pneumothorax. Studies were included if they published a sample size, mean chest wall thickness, and a standard deviation or confidence interval. A PubMed search was performed in a similar fashion. Sample size, mean chest wall thickness, and standard deviation were found or calculated for each study. Data were combined to create a pooled dataset. Normal distribution of data was assumed. Procedural success was defined as catheter length being equal to or greater than the chest wall thickness.

Results

The Medline and PubMed searches yielded 773 unique studies; all study abstracts were reviewed for possible inclusion. Eighteen papers were identified for full manuscript review. Thirteen studies met all inclusion criteria and were included in the analysis. Pooled sample statistics were: n=2,558; mean=4.19 cm; and SD=1.37 cm. Minimum catheter length needed for success at the 95th percentile for chest wall size was found to be 6.44 cm.

Discussion

A catheter of at least 6.44 cm in length would be required to ensure that 95% of the patients in this pooled sample would have penetration of the pleural space at the site of needle decompression, and therefore, a successful procedure. These findings represent Level III evidence.

ClemencyBM, TanskiCT, RosenbergM, MayPR, ConsiglioJD, LindstromHA. Sufficient Catheter Length for Pneumothorax Needle Decompression: A Meta-Analysis. Prehosp Disaster Med. 2015;30(3):15

Keywords

needle decompressionpneumothoraxprehospitalthoracostomy
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 30 , Issue 3 , June 2015 , pp. 249 - 253
Copyright
© World Association for Disaster and Emergency Medicine 2015 

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