1. Tube thoracostomy is performed to evacuate ongoing production of air and fluid into the pleural cavity. A tube is inserted through intercostal space 5 in the anterior axillary line (posterior approach). An incision is made at intercostal space 6, lateral to the nipple, but medial to the latissimus dorsi muscle.
2. The tube penetrates the following structures: skin superficial fascia serratus anterior muscle external intercostal muscle > internal intercostal muscle innermost intercostal muscle parietal pleura.
Innermost intercostal muscle Intercostal vein, artery, nerve Internal intercostal muscle External intercostal muscle
Figure 3-3. View of the lateral chest wall showing an intercostal space and layers. Note their relation to pleura and lung. Tube and diagram indicate the positioning for tube thoracostomy. Needle and diagram indicate the positioning for an intercostal nerve block. (Adapted with permission from Moore KL: Clinically Oriented Anatomy 3rd ed. Baltimore, Williams & Wilkins, 1992 p 57; upper inset reprinted with permission from Scott DB: Techniques of Regional Anaesthesia. East Norwalk, CT, Appleton & Lange, 1989, p 147; lower inset adapted with permission from Chen H, Sonneday CJ, Lille-moe KD, eds: Manual of Common Bedside Surgical Procedures, 2nd ed. Philadelphia, Lippincott Williams & Wilkins, 2000, p 123.)
Pleural cavity Parietal pleura
Innermost intercostal muscle Intercostal vein, artery, nerve Internal intercostal muscle External intercostal muscle intercostal —ace
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