A patient with a left-sided pleural effusion undergoes thoracocentesis. To avoid the intercostal neurovascular bundle, the needle should be inserted at which position relative to the rib?

• A Over the upper border of the rib below the desired intercostal space ✓
• B At the mid-point of the intercostal space
• C Near the lower border of the rib above the desired intercostal space
• D Directly through the costal cartilage

Explanation

The intercostal neurovascular bundle (vein, artery, nerve — VAN from above) runs in the costal groove on the inferior surface of each rib. Inserting the needle over the superior border of the rib below the chosen intercostal space keeps the needle away from the bundle running under the rib above, thereby avoiding haemorrhage and nerve injury. The mid-space position carries risk, particularly posterolaterally where collateral intercostal vessels run near the lower border of the space.

Reference: BD Chaurasia's Human Anatomy, 8th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.