Failure of First Attempt Needle Decompression in Tension Pneumothorax: Case Report

Tension pneumothorax can occur as a potentially life threatening complication of chest trauma. Tension pneumothorax is commonly treated with needle decompression, both the 2nd intercostal space in the midclavicular line and the 4th/5th intercostal space in the anterior axillary. A 45 years old man came to our emergency department after blunt injury of the chest presenting tension pneumothorax with unstable hemodynamic treated with needle decompression using 14 gauge (4.5 cm) cannula at 2nd intercostal space mid clavicular line, patient successfully recover and became hemodynamic stable, after 30 minutes of successful needle decompression patient experienced with recurrent tension pneumothorax. Several studies show the failure of needle decompression it may due to several factor such as chest wall thickness, cannula length, and location of the needle decompression. In this case the cannula may has insufficient length (4.5 cm) to pass through the full thickness of the patient’s chest wall at 2nd intercostal space mid clavicular line (ICS 2) and makes air leaks from the lung faster than it can escape through the cannula.