During a needle thoracocentesis for pneumothorax in emergency, the needle is inserted in the second intercostal space at the midclavicular line. To avoid injury to the intercostal neurovascular bundle, the needle should pass:

• A Under the lower border of the 2nd rib
• B Over the upper border of the 3rd rib ✓
• C Through the center of the intercostal space
• D At any point since the 2nd space has no neurovascular bundle

Explanation

The intercostal neurovascular bundle (posterior intercostal artery, vein, and nerve) runs in the costal groove on the inferior aspect of each rib, in the order vein–artery–nerve from superior to inferior. To avoid these structures, any needle or drain in the intercostal space must pass over (across the superior surface of) the lower rib — specifically the upper border of the 3rd rib when accessing the 2nd intercostal space. Passing under the 2nd rib risks the bundle lying in that groove. Mid-space is also prone to injuring vessels. There is no intercostal space without a neurovascular bundle.

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

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Written and medically reviewed by the StethoPrep medical team.