Skip to content

Research at St Andrews

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

Research output: Contribution to journalArticle

Author(s)

J. Bowness, P.M. Kilgour, S. Whiten, I. Parkin, J. Mooney, P. Driscoll

School/Research organisations

Abstract

Objectives: Guidelines to improve the ease and safety of chest drain insertion recommend using the fifth intercostal space, around the midaxillary line (MAL). This study aimed to assess whether compliance with published guidelines reliably ensured such placement and avoided the potentially serious complications of subdiaphragmatic insertion and peripheral nerve injury. Methods: Three international guidelines were assessed by identifying the intercostal space for chest drain insertion using 16 cadavers (32 sides) at a point 1 cm anterior to MAL. The European Trauma Course method was compared with the British Thoracic Society's 'safe triangle' and the ATLS course technique. Results: The level most commonly found was the sixth intercostal space (43%; 41 of 96 sides). Overall the sixth space or below was found in 83% of insertions (80 of 96 sides). In the fifth intercostal space, the long thoracic nerve ran posterior to the marker placed in all cases and the lateral cutaneous branches of intercostal nerves arose anteriorly to the marker in all but one case. Conclusions: The results suggest these guidelines may result in insertion of chest drains below the fifth intercostal space, potentially risking injury to subdiaphragmatic structures. Peripheral nerves of the lateral thoracic wall appear safe from incisions 1 cm anterior to MAL.
Close

Details

Original languageEnglish
Pages (from-to)620-625
Number of pages6
JournalEmergency Medicine Journal
Volume32
Issue number8
Early online date21 Nov 2014
DOIs
Publication statusPublished - Aug 2015

Discover related content
Find related publications, people, projects and more using interactive charts.

View graph of relations

Related by author

  1. Identifying variant anatomy during ultrasound-guided regional anaesthesia: opportunities for clinical improvement

    Bowness, J. S., Turnbull, K., Taylor, A., Halcrow, J., Raju, P., Mustafa, A., Chisholm, F., Varsou, O. & Grant, C., May 2019, In : British Journal of Anaesthesia. 122, 5, p. e75-e77 2 p.

    Research output: Contribution to journalLetter

  2. Identifying the emergence of the superficial peroneal nerve through deep fascia on ultrasound and by dissection: implications for regional anaesthesia in foot and ankle surgery

    Bowness, J., Turnbull, K., Taylor, A., Halcrow, J., Chisholm, F., Grant, C. & Varsou, O., 7 Jan 2019, In : Clinical Anatomy. Early View

    Research output: Contribution to journalArticle

  3. The definite risks and questionable benefits of liberal pre-hospital spinal immobilisation

    Purvis, T. A., Carlin, B. & Driscoll, P., Jun 2017, In : The American Journal of Emergency Medicine. 35, 6, p. 860-866 7 p.

    Research output: Contribution to journalArticle

  4. Human urinary exosomes in bladder cancer patients: properties, concentrations and possible clinical application

    Riches, A. C., Powis, S. J., Mullen, P., Harrison, D. J., Hacker, C., Lucocq, J. M., Bowness, J. S., Chapman, A., Cameron, R., McLornan, L., Chinn, D. J. & Leung, S., 11 Dec 2015, In : Bladder. 2, 3, 7 p., e19.

    Research output: Contribution to journalArticle

  5. Histopathology from the dissecting room: Are cadavers a suitable source of educationally useful histopathology specimens?

    Wood, A., Whiten, S. C., McVee, J., Issberner, J. P., Jackson, D. & Herrington, C. S., 2015, In : Journal of Anatomy. 9, 1, p. 26 – 33 7 p.

    Research output: Contribution to journalArticle

ID: 209412297

Top