Step I thoracocentesis

Started by cage92
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cage92

cage92

Full Member
10+ Year Member
hey in kaplan they say that it should be done slightly aboove the ribs
but uworld say on the inferior margin of the ribb i am confused
can anyone give me a good explanation and the relation of the artery and vein nerve to the ribs
 
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loveoforganic2 said:
Neurovascular bundle is on the inferior aspect of each rib, so you avoid the inferior margin of the rib superior to your injection point
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what means the explanation of uworld(inferior margine)?
and if i want to make a thoracocentesis in 4th space should i insert the needle below the 4th rib or above the 5th rib? above the 5th rib righ?
 
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cage92 said:
what means the explanation of uworld(inferior margine)?
and if i want to make a thoracocentesis in 4th space should i insert the needle below the 4th rib or above the 5th rib? above the 5th rib righ?
Click to expand...

You're confusing the location of the neurovascular bundle and the location of the pleural space. The UW question you're referring to is telling you which rib level to insert between the visceral and parietal peritoneum. The neurovascular bundle is beneath each rib
 
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loveoforganic2 said:
You're confusing the location of the neurovascular bundle and the location of the pleural space. The UW question you're referring to is telling you which rib level to insert between the visceral and parietal peritoneum. The neurovascular bundle is beneath each rib
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nono i am not confused i know the pleural space for the needle but i need clarification for the ribs when a clinical scenario give that fluuid collection on auscaltaion is headr on 4th space where the needle will be inserted? above 5th rib belowe4th rib...? if you cant answer dont mind really thanks
 
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The 4th intercostal space (ICS) is between the 4th and 5th ribs. Therefore, for thoracocentesis in the 4th ICS, you must insert the needle above the 5th rib.

Why is the other option, inserting the needle below the 4th rib wrong? It's because you should not insert needles below any rib because of the risk of hitting the neurovascular bundles which in the costal groove on the lower border of each rib.
 
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paul411 said:
The 4th intercostal space (ICS) is between the 4th and 5th ribs. Therefore, for thoracocentesis in the 4th ICS, you must insert the needle above the 5th rib.

Why is the other option, inserting the needle below the 4th rib wrong? It's because you should not insert needles below any rib because of the risk of hitting the neurovascular bundles which in the costal groove on the lower border of each rib.
Click to expand...

thannkss for explanation
 
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Nit for boards, but....I performed one with attending supervision last week and we went below the rib margin. Why? Because with age the nav bundle tends to sag. Imagine that. Ultrasound guided though, apparently no one does them blind anymore.

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Trogghunter said:
Nit for boards, but....I performed one with attending supervision last week and we went below the rib margin. Why? Because with age the nav bundle tends to sag. Imagine that. Ultrasound guided though, apparently no one does them blind anymore.

Sent from my Nexus 7 using SDN Mobile
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waww guys can anyone explain the difference between uworld and kaplan ?
uworld sau inferior margin and kaplen say upper border
is uworld incorrect?
 
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