Thoracocentesis for pleural effusion is typically performed in which intercostal space, and on which aspect of the rib to avoid neurovascular bundle injury?

• A 2nd intercostal space anteriorly; below the lower rib
• B 5th intercostal space; midline
• C 6th–9th intercostal space posteriorly/laterally; just above the upper border of the lower rib ✓
• D Any space; just below the upper rib to access the neurovascular bundle

Explanation

The intercostal neurovascular bundle (vein, artery, nerve — VAN from above down) runs in the costal groove at the inferior border of each rib. To avoid injury, the needle is inserted just above the upper border of the lower rib in the chosen interspace. For pleural effusion, the 6th–9th intercostal spaces in the posterior or mid-axillary line are used. The 2nd intercostal space anteriorly is the site for tension pneumothorax decompression. Inserting below the upper rib risks the neurovascular bundle.

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

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Written and medically reviewed by the StethoPrep medical team.