Guidelines for chest drain insertion may not prevent damage to abdominal viscera

Area of Science:

• Thoracic Surgery
• Anatomy
• Medical Guidelines

Background:

• Chest drain insertion guidelines recommend the fifth intercostal space near the midaxillary line (MAL) for safety and ease.
• Potential complications include subdiaphragmatic insertion and peripheral nerve injury.

Purpose of the Study:

• To evaluate if current guidelines ensure correct chest drain placement.
• To assess the risk of complications like subdiaphragmatic insertion and nerve injury.

Main Methods:

• Sixteen cadavers (32 sides) were used to identify the intercostal space 1 cm anterior to MAL.
• Techniques from the European Trauma Course, British Thoracic Society, and ATLS were compared.

Main Results:

• The sixth intercostal space was the most common insertion level (43%).
• 83% of insertions were at or below the sixth intercostal space.
• Peripheral nerves were located relative to the insertion marker.

Conclusions:

• Published guidelines may lead to chest drain insertion below the fifth intercostal space, increasing risk to subdiaphragmatic structures.
• Incisions 1 cm anterior to MAL appear safe for lateral thoracic wall peripheral nerves.