Source
r/step1•
fifaproblems

Zanki cards conflicting on thoracentesis anatomy?

One card: thoracentesis is ideally performed at the 7th ICS midclavicular line, 9th ICS midaxillary line, 11th ICS paravertebral line/posterior scapular line.

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Another card: Would you be able to aspirate pleural cavity fluid from the 9th or 10th ICS at the midaxillary line without penetrating other structures?

No because**:**

- Spleen is protected by 9th - 11th ribs
- Liver can be from 6th ICS to 10th ICS
Don't these cards directly contradict each other - can anyone offer an explanation?

Posted May 14, 2020, 5:24 PM UTC

33
BlindOphthalmologist•

https://www.reddit.com/r/medicalschoolanki/comments/d5z41b/card_discrepancy_on_needle_placement_for/

3
fifaproblemsOP•

oh lol awesome - thanks. I guess I wasn't the only one that noticed this.

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So it sounds like the card about the 3 different ideal insertion locations is really just answering the question of "Where can I best access the pleural space from the front, the side, and the back" while the other card is asking "Should I access the pleural space in the 9th or 10th ICS midaxillary line (answer = no because there's risk for hitting abdominal structures)"

5
Litty3Titties•

Doesn't the card say "would you be able to posteriorly aspirate...?" So 9th ICS midaxillary you're fine, but posterior 9th ICS you can't because of the spleen on the left and liver on the right

2
fifaproblemsOP•

Mine doesn't say "posteriorly" - also, I've gotten the sense from zanki that "mid-axillary" tends to refer to a lateral approach (mid-clavicular implies anterior, and para-vertebral implies posterior)

2