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Needle decompression in tension pneumothorax: anterior or lateral approach?

02 August 2021
Volume 13 · Issue 8



For tension pneumothorax, the UK recommendation is to use a 14 g, 5 cm cannula to decompress the chest. Advice around site selection differs between using the second intercostal space (ICS) mid-clavicular line or the fifth ICS near the mid-axillary line. The aim of this literature review is to determine the best approach for needle decompression using a standard 14 g, 5 cm cannula.


A systematic search of multiple databases was conducted, using inclusion and exclusion criteria. Outcomes were tabulated to identify any trends between various criteria including success with a 5 cm cannula.


Thirty-one studies were found, of which four were included. Mean chest wall thickness was 35.8 mm at the anterior site and 39.7 mm at the lateral site. Overall success rates with a 5 cm catheter were on average 79.7% at the anterior and 80% at the lateral position.


There is no significant difference in success between using the anterior or the lateral approach for needle decompression.

Serious thoracic trauma accounts for one in four trauma deaths in the UK. This is more than 4000 deaths per year (National Institute for Health and Care Excellence (NICE), 2016). The recognition and successful management of life-threatening complications in this patient group will increase survival.

Tension pneumothorax is a life-threatening condition occurring in 1 in 250 patients experiencing major trauma (Leech et al, 2013), and a failure to recognise and intervene will lead to patient deterioration. A pneumothorax occurs when air leaks into the pleural cavity from the lungs or from outside the body. This becomes a tension pneumothorax when continued inspiration allows more air into the pleural cavity. The negative pressures in the lungs, needed for spontaneous breathing, are unable to overcome the atmospheric pressure in the pleural cavity, and the lung begins to collapse, collapsing further with each breath.

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