I have to disagree. The nipple is usually at the level of the 5th
intercostal space as an ANTERIOR landmark (and approximate, as has been
mentioned). However I find that due to the curvature of the ribs
(curving superiorly) the nipple level, when traced directly laterally,
actually corresponds to the 7th or 8th intercostal space in the mid
axillary line. I clearly remember being surprised as to how high in
the axilla the 5th intercostal space was when I was inserting my first
chest drains.
I know that this is small print, but I have seen chest drains inserted
as peritoneal drains due to this.
On the topic of the main thread, I insert my chest drains in the 5th
space, just anterior to the mid axilliary line. I have found the
small seldinger drains (made by Arrow, I think) useful, and less
uncomfortable for patients, although they often need replaced in the
case of larger pneumothoraces that fail to expand. I would prefer to
at least try an aspiration/seldinger drain if I was a patient with a
spontaneous pnemothorax.
Regards
Alistair Murray
SpR, Dublin
On 31 Mar 2005, at 12:44, Tony Adams wrote:
> In reply to:
>
>>> Taking into consideration the relative short duration the drain needs
>>> to stay in for and cosmetic appearance, the "triangle of safety"
>>> bounded by the
>>> posterior border of pect. major, the mid axillary line and
>>> the level of the
>>> nipple, is probably the preferred site.
>
> Matt Dunn said:
>
>> I'd have thought of that as being a bit low- I generally go for the
>> fifth
> intercostal space
>> which is better cosmetically and a bit less in the way of worrying
>> anatomy
> under your incision.
>
>
> I'm sure that when I last checked the nipple/mammary line was at the
> level
> of the fourth intercostal space or fifth rib, but as with these things,
> opinions may vary !-)
>
> Tony Adams
>
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