Needle thoracostomy: implications of computed tomography chest wall thickness

Acad Emerg Med. 2004 Feb;11(2):211-3.


Objectives: To determine the length of catheter required to perform a needle thoracostomy, as determined by chest wall thickness, to treat the majority of patients presenting to the emergency department (ED) with a potential tension pneumothorax.

Methods: A convenience sample of 111 computed tomography (CT) scans of the chest in trauma and medical resuscitation patients at a military Level 1 trauma center in San Antonio, Texas, was pooled, and the chest wall thickness was measured at the second intercostal space, midclavicular line, to the nearest 0.1 cm.

Results: The mean chest wall thickness in the patients studied averaged 4.24 cm (95% confidence interval [CI] = 3.97 to 4.52). Nearly one fourth (25) of the study patients had a chest wall thicker than 5 cm. Women, on average, have thicker chest walls than men (4.90 for women; 4.16 for men; p = 0.022).

Conclusions: In this study, a catheter length of 5 cm would reliably penetrate the pleural space of only 75% of patients. A longer catheter should be considered, especially in women.

Publication types

  • Comparative Study

MeSH terms

  • Catheterization / methods
  • Chest Tubes
  • Emergency Medical Services / methods*
  • Equipment Design
  • Female
  • Humans
  • Male
  • Pneumothorax / diagnostic imaging*
  • Pneumothorax / surgery*
  • Retrospective Studies
  • Sex Factors
  • Thoracic Wall / diagnostic imaging*
  • Thoracostomy / methods*
  • Tomography, X-Ray Computed