Diaphragm Needle Placement Techniques Evaluated in Cadaveric Specimens

Chiodo A, Goodmurphy C, Haig A. Diaphragm needle placement techniques evaluated in cadaveric specimens. Objective: To evaluate the safest and most accurate method of diaphragm needle placement for electromyography. Design: Single blinded study. Setting: University anatomy laboratory. Cadavers: Five cadavers. Interventions: Needle placement in the diaphragm by an American Board of Electrodiagnostic Medicine physician, blinded dissection by a doctoral candidate anatomist. Main Outcome Measures: Accurate needle placement in the diaphragm, proximity or penetration of organs, vessels, or nerves, defined as cautions (proximity) and dangers (penetration). Results: The anterior axillary approach was most accurate at the above-the-seventh and eighth-rib locations. The risk of dangers of needle placement in the diaphragm was greater on the right than left side. Conclusions: Needle placement in the diaphragm is safe and most accurate at the anterior axillary line superior to the eighth rib. If the side of needle placement does not matter for the study being done, the left side should be chosen because it leads to a lower risk of danger to the patient.