Between which ribs is a chest tube typically inserted?

A chest tube is typically inserted between the fourth and fifth ribs. This specific intercostal space is preferred for several reasons. The area is located in the midaxillary line, which allows for effective drainage of fluid, air, or blood from the pleural cavity while minimizing potential damage to underlying structures. In this space, the intercostal vessels and nerves are located more towards the bottom of the rib, which reduces the risk of injury during insertion.

Inserting the chest tube in this position also allows for easier access to the pleural space, facilitating procedures like drainage in cases of pleural effusion, pneumothorax, or hemothorax. Placing the tube too high, such as between ribs 2 and 3, may not adequately drain fluid, while placing it too low could risk injuring organs, such as the diaphragm or abdominal viscera. Therefore, the location between the fourth and fifth ribs is considered the safest and most effective choice for insertion.