Thoracentesis

Indications

1. New-onset pleural effusion (except obvious CHF-induced effusion)
2. Symptomatic pleural effusion

Relative Contraindications

1. Plt <50K
2. INR >2x normal
3. Mechanical ventilation

Equipment Needed

1. Thoracentesis kit
2. Sterile gloves
3. Chlorhexidine scrub
4. Evacuated container

1. Labs
   1. Protein, gluc, LDH, gram stain, culture, cell count, amylase, pH, TB, fungal, cytology
   2. Send serum LDH, protein at same time

Procedure

1. Choose insertion site/positioning
   1. Upright position in mid-scapular or posterior axillary line (usual technique)
   2. Lateral decubitus position w/ fluid side down in post axillary line (if cannot sit up)
   3. Supine w/ head elevated as much as possible in midaxillary line (chest tube location)
2. Prep skin
3. Anesthetize skin
   1. Raise wheal and advance/inject along superior aspect of lower rib (avoid NV bundle)
4. Puncture skin w/ scalpel (optional)
5. Insert/advance catheter while continuously aspirating until pleural space is entered
6. Drain fluid
7. Post-procedure CXR only necessary if:
   1. Multiple needle passes required
   2. Air is aspirated
   3. Risk of adhesions
   4. New-onset of symptoms during the procedure (chest pain, dyspnea)
   5. pts at high risk for decompensation from small ptx (lung dz, mechanical ventilation)

Complications

1. Pneumothorax
2. Cough (9%)
3. Unilateral pulmonary edema
4. Reexpansion pulmonary edema
5. Transient hypoxia from V-Q mismatch
6. Hemothorax
7. Infection (2%)
8. Hemoperitoneum

See Also

Pleural Effusion

Source

Robert and Hedges, p.145 (130-147)