Thoracentesis: Difference between revisions
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*Symptomatic pleural effusion | *Symptomatic pleural effusion | ||
== | ==Contraindications== | ||
{{Thoracentesis with coagulopathy}} | {{Thoracentesis with coagulopathy}} | ||
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*Thoracentesis kit | *Thoracentesis kit | ||
*Sterile gloves | *Sterile gloves | ||
*Chlorhexidine scrub | *Chlorhexidine or betadine scrub | ||
*Evacuated container | *Evacuated container | ||
*Ultrasound | *Ultrasound | ||
==Procedure== | ==Procedure== | ||
| Line 22: | Line 18: | ||
**Lateral decubitus position w/ fluid side down in post axillary line (if cannot sit up) | **Lateral decubitus position w/ fluid side down in post axillary line (if cannot sit up) | ||
**Supine w/ head elevated as much as possible in midaxillary line (chest tube location) | **Supine w/ head elevated as much as possible in midaxillary line (chest tube location) | ||
* | *Cleanse skin with chlorhexidine or betadine | ||
*Anesthetize skin | *Anesthetize skin and subcutaneous tissue - raise wheal and advance/inject along superior aspect of lower rib (avoid NV bundle) | ||
*Make small skin nick with scalpel | |||
* | *Insert/advance needle while continuously aspirating until pleural space is entered | ||
*Insert/advance | *Advance catheter into pleural space while removing needle | ||
* | *Connect tubing to catheter and to evacuated container and remove desired amount of fluid | ||
* | |||
*Obtain post-procedure CXRif: | |||
**Multiple needle passes required | **Multiple needle passes required | ||
**Air is aspirated | **Air is aspirated | ||
**Risk of adhesions | **Risk of adhesions | ||
**New-onset of symptoms during the procedure (chest pain, dyspnea) | **New-onset of symptoms during the procedure (chest pain, dyspnea) | ||
** | **Pt at high risk for decompensation from small ptx (lung disease, positive pressure ventilation) | ||
==Complications== | ==Complications== | ||
Revision as of 07:15, 6 September 2015
Indications
- New-onset pleural effusion (except obvious CHF-induced effusion)
- Symptomatic pleural effusion
Contraindications
Thoracentesis if coagulopathic
Equipment Needed
- Thoracentesis kit
- Sterile gloves
- Chlorhexidine or betadine scrub
- Evacuated container
- Ultrasound
Procedure
- Choose insertion site/positioning
- Upright position in mid-scapular or posterior axillary line (usual technique)
- Lateral decubitus position w/ fluid side down in post axillary line (if cannot sit up)
- Supine w/ head elevated as much as possible in midaxillary line (chest tube location)
- Cleanse skin with chlorhexidine or betadine
- Anesthetize skin and subcutaneous tissue - raise wheal and advance/inject along superior aspect of lower rib (avoid NV bundle)
- Make small skin nick with scalpel
- Insert/advance needle while continuously aspirating until pleural space is entered
- Advance catheter into pleural space while removing needle
- Connect tubing to catheter and to evacuated container and remove desired amount of fluid
- Obtain post-procedure CXRif:
- Multiple needle passes required
- Air is aspirated
- Risk of adhesions
- New-onset of symptoms during the procedure (chest pain, dyspnea)
- Pt at high risk for decompensation from small ptx (lung disease, positive pressure ventilation)
Complications
- Pneumothorax (4-19%)
- Cough (9%)
- Infection (2%)
- Hemothorax
- Splenic rupture
- Reexpansion pulmonary edema
- Dyspnea, tachypnea, cough, frothy sputum
- Tx with aggressive volume resuscitation