Indeed - Age, sex and body habitus - and to follow Danny's theme - don't
forget that Astley-Cooper's anti-droopers are less effective as age
increases, thus lowering the nipple position. However as everybody else has
stated, the nipple does lie anteriorly at the 5th space. I generally follow
the line of the rib laterally and posteriorly, and then go one space up.
Don't worry Danny. Us young 'uns like mnemonics too!
Simon Odum
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]]On Behalf Of Andy Webster
Sent: 31 March 2005 12:48
To: [log in to unmask]
Subject: Re: chest drains
The position of the nipple/mammary line will that not depend on the sex,
age, and habitus of the patient?
Andy Webster
Registrar in Emergency Medicine
Sir Charles Gairdner Hospital
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Tony Adams
Sent: 31 March 2005 19:44
To: [log in to unmask]
Subject: Re: chest drains
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 can vary !-)
Tony Adams
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