Thoracentesis

Revision as of 20:08, 13 May 2015 by Rossdonaldson1 (talk | contribs) (Source)

Indications

  • New-onset pleural effusion (except obvious CHF-induced effusion)
  • Symptomatic pleural effusion

Relative Contraindications

Thoracentesis if coagulopathic

  • Platelets <50K[1]
  • INR >2x normal[1]
  • Mechanical ventilation

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

Pleural Effusion

References

  1. 1.0 1.1 McVay P. et al. Lack of increased bleeding after paracentesis and thoracentesis in patients with mild coagulation abnormalities. Transfusion. 1991 Feb;31(2):164-71