asked 10 months ago
For pediatrics presenting with a tension pneumothorax, the supplied 14G angiocath would be much too large. What would the appropriate needle gauge be? Can we use an IV catheter to manage this patient condition?
In reference to a 2019 study, it is suggested for children 0-10 years of age, use of a 22G, 20G, 18G, with favour of 22G, including 24G in neonates are most deemed appropriate.
(Leonhard G, Overhoff D, Wessel L, Viergutz T, Rudolph M, Schöler M, Haubenreisser H, Terboven T. Determining optimal needle size for decompression of tension pneumothorax in children - a CT-based study. Scand J Trauma Resusc Emerg Med. 2019 Oct 11;27(1):90. doi: 10.1186/s13049-019-0671-x. PMID: 31604472; PMCID: PMC6788035.)
1 Answers
answered 10 months ago
Thank you for your question. Yes, with everything in the pediatric world, adult equipment and sizes does not extrapolate to the pediatric patient. You are correct in your determination that the length of the 14 gauge angiocath would be too large for the pediatric chest, therefore we go by the age of the patient to determine the appropriate size as per the ALS PCS companion document. When determining the catheter sizing for pediatrics, the age of the patient should be taken into consideration. Pediatrics that are adolescents of adult size, should be treated as adults and a needle thoracostomy should be performed using the 4th intercostal space anterior axillary line with a minimum of a 14G 2 inch angiocath needle.
For pediatrics that are less than 13 years of age, or small adolescents, a 14G or 16G 1.5 inch angiocath needle is appropriate for performing a needle thoracostomy. Any needle that is longer can increase the risk of iatrogenic injury to the patient. A 2-inch needle is more than double the chest wall thickness of most children. The 2nd intercostal space is the preferred location for this patient population.
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