During needle thoracocentesis for tension pneumothorax, the needle is inserted in the second intercostal space, midclavicular line. The needle is placed at the upper border of the third rib because:

• A The neurovascular bundle runs along the upper border of each rib
• B The pleura is thicker at the inferior border and needle penetration is easier superiorly
• C The neurovascular bundle runs along the inferior border of each rib (costal groove), and inserting above the rib avoids injury ✓
• D The phrenic nerve runs along the upper rib border and must be avoided

Explanation

The intercostal neurovascular bundle (vein-artery-nerve, VAN from top to bottom) runs in the costal groove along the inferior border of each rib, protected by the subcostal shelf. Inserting a needle immediately above the upper border of the lower rib (e.g., upper border of rib 3 in the 2nd ICS) avoids the neurovascular bundle of the space above. Inserting below the upper rib risks damaging the bundle. This principle applies to all intercostal procedures including chest tube insertion.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.