What Size Needle Should You Use?
At a recent course this past weekend, we were asked which size needle should you use while performing a needle decompression procedure. The automatic response was large bore needle…typically 14-gauge angiocatheter. But that is only half the answer! What about catheter length? The standard 14-g angiocath is 5cm long and its catheter is only 4.5cm long. This was causing concern about a high failure rate. With the primary source of procedure failure being a failure of the needle to reach the pleural space, the standard angiocath would only reach the pleural space in 53% of the population.
In fact, due to the increased size of American patients, and the amount of both muscle and adipose tissue causing increased thickness of the chest wall. In fact, concern about passing through the pectoral muscle and intercostals is also leading many to reconsider the classic location of the midclavicular line, second intercostal space, in favor of the left 4th or 5th intercostal space in the mid-axillary line. This second position is the classic location of a proper chest tube, where there may be less soft tissue to interfere with decompression.
A 2016 meta-analysis of 13 studies evaluated this topic using radiographic evidence of needle compression as the benchmark of success. The studies found that the standard 5-cm angiocath would give you only a 65% success rate. If you used a 6.5cm catheter, your success rate would rocket to 95%. To achieve 100% success rate, you would need to use an 8-cm catheter. Consequently, International Trauma Life Support guidelines now recommend using a 6-9cm catheter when performing needle decompression.
Regardless of the length of the needle you use, the most important part of needle decompression is identifying the correct location for emergent decompression and feeling comfortable performing this intervention. Provider Practice Essentials will arm you with the knowledge to know when to perform this life-saving intervention, the skills and training to perform it, and the confidence to include this in your skill set for your practice.