Thoracentesis: Difference between revisions
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==Indications== | ==Indications== | ||
*New-onset pleural effusion (except obvious CHF-induced effusion) | |||
*Symptomatic pleural effusion | |||
==Relative Contraindications== | ==Relative Contraindications== | ||
*Plt <50K | |||
*INR >2x normal | |||
*Mechanical ventilation | |||
See also [[Procedures in Patients with Coagulopathies]] | See also [[Procedures in Patients with Coagulopathies]] | ||
==Equipment Needed== | ==Equipment Needed== | ||
*Thoracentesis kit | |||
*Sterile gloves | |||
*Chlorhexidine scrub | |||
*Evacuated container | |||
*Ultrasound | |||
===Labs=== | ===Labs=== | ||
**Protein, gluc, LDH, gram stain, culture (blood cx bottle), cell count, amylase, pH, TB (adenosine deaminase), fungal, cytology | |||
**Send serum LDH, protein at same time | |||
==Procedure== | ==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) | |||
*Prep skin | |||
*Anesthetize skin | |||
**Raise wheal and advance/inject along superior aspect of lower rib (avoid NV bundle) | |||
*Puncture skin w/ scalpel (optional) | |||
*Insert/advance catheter while continuously aspirating until pleural space is entered | |||
*Drain fluid | |||
*Post-procedure CXR only necessary if: | |||
**Multiple needle passes required | |||
**Air is aspirated | |||
**Risk of adhesions | |||
**New-onset of symptoms during the procedure (chest pain, dyspnea) | |||
**pts at high risk for decompensation from small ptx (lung dz, on ventilator) | |||
==Complications== | ==Complications== | ||
*Pneumothorax (4-19%) | |||
*Cough (9%) | |||
*Infection (2%) | |||
*Hemothorax | |||
*Splenic rupture | |||
*Reexpansion pulmonary edema | |||
**Dyspnea, tachypnea, cough, frothy sputum | |||
**Tx with aggressive volume resuscitation | |||
==See Also== | ==See Also== | ||
Revision as of 20:05, 13 May 2015
Indications
- New-onset pleural effusion (except obvious CHF-induced effusion)
- Symptomatic pleural effusion
Relative Contraindications
- Plt <50K
- INR >2x normal
- Mechanical ventilation
See also Procedures in Patients with Coagulopathies
Equipment Needed
- Thoracentesis kit
- Sterile gloves
- Chlorhexidine scrub
- Evacuated container
- Ultrasound
Labs
- Protein, gluc, LDH, gram stain, culture (blood cx bottle), cell count, amylase, pH, TB (adenosine deaminase), fungal, cytology
- Send serum LDH, protein at same time
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)
- Prep skin
- Anesthetize skin
- Raise wheal and advance/inject along superior aspect of lower rib (avoid NV bundle)
- Puncture skin w/ scalpel (optional)
- Insert/advance catheter while continuously aspirating until pleural space is entered
- Drain fluid
- Post-procedure CXR only necessary if:
- Multiple needle passes required
- Air is aspirated
- Risk of adhesions
- New-onset of symptoms during the procedure (chest pain, dyspnea)
- pts at high risk for decompensation from small ptx (lung dz, on ventilator)
Complications
- Pneumothorax (4-19%)
- Cough (9%)
- Infection (2%)
- Hemothorax
- Splenic rupture
- Reexpansion pulmonary edema
- Dyspnea, tachypnea, cough, frothy sputum
- Tx with aggressive volume resuscitation
See Also
Source
- Robert and Hedges
- Tintinalli