A negative pressure drain (chest tube) must be inserted into the pleural space in order to remove either fluid or air that normally is not present. Effective locations for the drain include which of the following?
1.Apex between the clavicle and first rib
2.Costomediastinal recess on the left , adjacent to the xiphoid process
3.Right fourth intercostal space in the midclavicular line (just below the nipple)
4.Right fourth intercostal space in the midaxillary line
5.Right eighth intercostal space in the midclavicular line (about in 4 in. below the nipple)
The usual location of choice for a chest tube drain is in the midaxillary or posterior axillary line, that is, the vertical line commencing at the middle or posterior axillary fold, at the approximate level of the fifth or sixth intercostal space. Since the lung is collapsed toward the hilum the exact level tends not to be so important since the lung has pull cranial and medial. The needle is usually inserted just below the level at which percussive dullness occurs (if hemothorax). The apex of the lung (answer a) is close to the brachial plexus and subclavian vessels and thus is not used. The costomediastinal recess on the left, adjacent to the xiphoid process (answer b) is used for pericardiocentesis. The midclavicular line (answers c and e) is not used because tubes placed this far anteriorly tend to be in the way of the patient.