Needle thoracocentesis in tension pneumothorax: insufficient cannula length and potential failure

Injury. 1996 Jun;27(5):321-2. doi: 10.1016/0020-1383(96)00007-1.


Advanced Trauma Life Support guidelines recommend the use of a cannula 3 to 6 cm long to perform needle thoracocentesis for life-threatening tension pneumothorax. The chest wall thickness in the 2nd intercostal space, mid-clavicular line, was determined by ultrasound in 54 patients aged 18 to 55 years, and ranged from 1.3 to 5.2 cm (mean 3.2 cm). In thirty-one patients (57 per cent) the chest-wall thickness (CWT) was greater than 3 cm, the minimum recommended cannula length, although in only two (4 per cent) was it greater than 4.5 cm, the length of cannula commonly used in the UK. As a 3 cm cannula would fail to reach the pleural cavity in over half of patients, we suggest that the recommended shortest length be increased to 4.5 cm. Unsuccessful needle thoracocentesis using a 4.5 cm cannula should be followed immediately by insertion of a longer cannula or a definitive chest drain.

MeSH terms

  • Adolescent
  • Adult
  • Chest Tubes*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pneumothorax / pathology
  • Pneumothorax / surgery*
  • Thoracostomy / instrumentation*
  • Thoracostomy / methods
  • Treatment Failure