Skip to main content Accessibility help

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

  • Brian M. Clemency (a1), Christopher T. Tanski (a2), Michael Rosenberg (a3), Paul R. May (a1), Joseph D. Consiglio (a4) and Heather A. Lindstrom (a1)...



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.


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.


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.


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.

Clemency BM , Tanski CT , Rosenberg M , May PR , Consiglio JD , Lindstrom HA . Sufficient Catheter Length for Pneumothorax Needle Decompression: A Meta-Analysis. Prehosp Disaster Med. 2015;30(3):1 5


Corresponding author

Correspondence: Brian M. Clemency, DO Department of Emergency Medicine Erie County Medical Center 462 Grider St. Buffalo, New York 14215 USA E-mail:


Hide All
1. Eckstein, M, Suyehara, D. Needle thoracostomy in the prehospital setting. Prehosp Emerg Care. 1998;2(2):132-135.
2. Warner, KJ, Copass, MK, Bulger, EM. Paramedic use of needle thoracostomy in the prehospital environment. Prehosp Emerg Care. 2008;12(2):162-168.
3. Cullinane, DC, Morris, JA Jr., Bass, JG, Rutherford, EJ. Needle thoracostomy may not be indicated in the trauma patient. Injury. 2001;32(10):749-752.
4. Barton, ED, Epperson, M, Hoyt, DB, Fortlage, D, Rosen, P. Prehospital needle aspiration and tube thoracostomy in trauma victims: a six-year experience with aeromedical crews. J Emerg Med. 1995;13(2):155-163.
5. Ball, CG, Wyrzykowski, AD, Kirkpatrick, AW, et al. Thoracic needle decompression for tension pneumothorax: clinical correlation with catheter length. Can J Surg. 2010;53(3):184-188.
6. Inaba, K, Branco, BC, Eckstein, M, et al. Optimal positioning for emergent needle thoracostomy: a cadaver-based study. J Trauma. 2011;71(5):1099-1103.
7. American College of Surgeons’ Committee on Trauma. Advanced Trauma Life Support Student Course Manual. 9th ed. Chicago, Illinois USA: American College of Surgeons; 2012.
8. Alson, R, Braithwaite, S. International trauma life support: needle decompression of tension pneumothorax: International Trauma Life Support; 2014. Accessed September 30, 2014.
9. NAEMT, American College of Surgeons’ Committee on Trauma. PHTLS Prehospital Trauma Life Support. 7th ed. Burlington, Massachusetts USA: Jones & Bartlett Learning, LLC; 2011.
10. Stevens, RL, Rochester, AA, Busko, J, et al. Needle thoracostomy for tension pneumothorax: failure predicted by chest computed tomography. Prehosp Emerg Care. 2009;13(1):14-17.
11. Chang, SJ, Ross, SW, Kiefer, DJ, et al. Evaluation of 8.0-cm needle at the fourth anterior axillary line for needle chest decompression of tension pneumothorax. J Trauma Acute Care Surg. 2014;76(4):1029-1034.
12. Akoglu, H, Akoglu, EU, Evman, S, et al. Determination of the appropriate catheter length and place for needle thoracostomy by using computed tomography scans of pneumothorax patients. Injury. 2013;44(9):1177-1182.
13. Carter, TE, Mortensen, CD, Kaistha, S, Conrad, C, Dogbey, G. Needle decompression in appalachia do obese patients need longer needles? West J Emerg Med. 2013;14(6):650-652.
14. Givens, ML, Ayotte, K, Manifold, C. Needle thoracostomy: implications of computed tomography chest wall thickness. Acad Emerg Med. 2004;11(2):211-213.
15. Harcke, HT, Pearse, LA, Levy, AD, Getz, JM, Robinson, SR. Chest wall thickness in military personnel: implications for needle thoracentesis in tension pneumothorax. Mil Med. 2007;172(12):1260-1263.
16. Inaba, K, Ives, C, McClure, K, et al. Radiologic evaluation of alternative sites for needle decompression of tension pneumothorax. Arch Surg. 2012;147(9):813-818.
17. McLean, AR, Richards, ME, Crandall, CS, Marinaro, JL. Ultrasound determination of chest wall thickness: implications for needle thoracostomy. Am J Emerg Med. 2011;29(9):1173-1177.
18. Powers, WF, Clancy, TV, Adams, A, West, TC, Kotwall, CA, Hope, WW. Proper catheter selection for needle thoracostomy: a height and weight-based criteria. Injury. 2014;45(1):107-111.
19. Sanchez, LD, Straszewski, S, Saghir, A, et al. Anterior versus lateral needle decompression of tension pneumothorax: comparison by computed tomography chest wall measurement. Acad Emerg Med. 2011;18(10):1022-1026.
20. Schroeder, E, Valdez, C, Krauthamer, A, et al. Average chest wall thickness at two anatomic locations in trauma patients. Injury. 2013;44(9):1183-1185.
21. Yamagiwa, T, Morita, S, Yamamoto, R, Seki, T, Sugimoto, K, Inokuchi, S. Determination of the appropriate catheter length for needle thoracostomy by using computed tomography scans of trauma patients in Japan. Injury. 2012;43(1):42-45.
22. Zengerink, I, Brink, PR, Laupland, KB, Raber, EL, Zygun, D, Kortbeek, JB. Needle thoracostomy in the treatment of a tension pneumothorax in trauma patients: what size needle? J Trauma. 2008;64(1):111-114.
23. Moher, D, Liberati, A, Tetzlaff, J, Altman, DG, Group, P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264-269, W64.
24. American Academy of Pediatrics, American College of Emergency Physicians, American College of Surgeons Committee on Trauma, Emergency Medical Services for Children, Emergency Nurses Association, National Association of EMS Physicians, National Association of State EMS Officials. Equipment for ground ambulances. Prehosp Emerg Care. 2014;18(1):92-97.
25. Centers for Disease Control and Prevention. Obesity--United States, 1999-2010. MMWR. 2013;62(Suppl 3):120-128.
26. World Health Organization. Obesity: Preventing and Managing the Global Epidemic. Geneva, Switzerland: WHO; 2000.
27. Butler, KL, Best, IM, Weaver, WL, Bumpers, HL. Pulmonary artery injury and cardiac tamponade after needle decompression of a suspected tension pneumothorax. J Trauma. 2003;54(3):610-611.
28. Rawlins, R, Brown, KM, Carr, CS, Cameron, CR. Life threatening haemorrhage after anterior needle aspiration of pneumothoraces. A role for lateral needle aspiration in emergency decompression of spontaneous pneumothorax. Emerg Med J. 2003;20(4):383-384.
29. Davis, DP, Pettit, K, Rom, CD, et al. The safety and efficacy of prehospital needle and tube thoracostomy by aeromedical personnel. Prehosp Emerg Care. 2005;9(2):191-197.
30. Heng, K, Bystrzycki, A, Fitzgerald, M, et al. Complications of intercostal catheter insertion using EMST techniques for chest trauma. ANZ J Surg. 2004;74(6):420-423.


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

  • Brian M. Clemency (a1), Christopher T. Tanski (a2), Michael Rosenberg (a3), Paul R. May (a1), Joseph D. Consiglio (a4) and Heather A. Lindstrom (a1)...


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed