Prehosp Emerg Care. 2021 Nov-Dec;25(6):747-752. doi: 10.1080/10903127.2020.1831670. Epub 2020 Nov 3.
Needle decompression of tension pneumothorax in children is a rarely encountered but potentially life-saving procedure, that is accompanied by a certain risk of injury. We evaluated the nipple as a landmark for an alternative anterior insertion site and as an aid in localizing lateral insertion sites, as well as its influence on the safety profile of the procedure.
In thoracic computer tomography scans of children aged 0-10 years, the distance to the closest vital structure was compared between the traditional anterior insertion site (2nd intercostal space midclavicular line) and an alternative anterior insertion site (2nd intercostal space at the nipple line). Furthermore, the level of the nipple at the midaxillary line was investigated as guidance in quickly localizing the lateral insertion site and ensuring an insertion site high enough to avoid intraabdominal injury by the decompression needle. Additionally, correlation of these measures with age was investigated.
The distance to the closest vital structure at the 2nd intercostal space was significantly bigger at the nipple line compared to the midclavicular line (right: 2.23 ± 1.13 cm vs. 0.99 ± 0.80 cm, p < 0.0001; left: 1.92 ± 1.19 cm vs. 0.81 ± 0.70 cm, p < 0.0001). At the midaxillary line, the level of the nipple was at the 4th or 5th intercostal space in the majority of children (right: 83.8%; left: 88.1%). The mean distance from the nipple to the diaphragmatic cupola was 2.63 ± 1.85 cm on the right and 3.40 ± 1.86 cm on the left hemithorax.
When performing anterior needle decompression in children, we recommend inserting the needle at the more lateral insertion site at the 2nd intercostal space at the nipple line. At the lateral decompression sites, the nipple can be used as a marker for localizing the correct intercostal space for insertion and thereby ensuring enough caudad distance to the diaphragm to avoid abdominal injury.
儿童张力性气胸的针式减压是一种罕见但具有潜在救生作用的操作，伴有一定的损伤风险。我们评估了乳头作为替代前入路置钉点的标志，以及作为定位外侧入路置钉点的辅助标志，同时还评估了其对该操作安全性的影响。
在 0-10 岁儿童的胸部计算机断层扫描中，比较了传统前入路（第 2 肋间隙锁骨中线）和替代前入路（第 2 肋间隙乳头线）的最近生命结构距离。此外，还研究了腋中线处乳头的水平位置，以快速定位外侧入路置钉点，并确保置钉点足够高，以避免减压针造成的腹腔内损伤。还研究了这些措施与年龄的相关性。
第 2 肋间隙处，与锁骨中线相比，乳头线处最近生命结构的距离明显更大（右侧：2.23±1.13cm 比 0.99±0.80cm，p<0.0001；左侧：1.92±1.19cm 比 0.81±0.70cm，p<0.0001）。在腋中线处，大多数儿童的乳头水平位于第 4 或第 5 肋间隙（右侧：83.8%；左侧：88.1%）。右侧膈穹顶至乳头的平均距离为 2.63±1.85cm，左侧为 3.40±1.86cm。
在儿童中进行前侧针式减压时，我们建议将针插入第 2 肋间隙乳头线的更外侧入路置钉点。在外侧减压部位，乳头可作为定位正确的肋间隙置钉点的标志，从而确保足够的向尾侧距离至膈肌，以避免腹部损伤。
