Thoracentesis

Updated: Apr 24, 2017
  • Author: Mark E Brauner, DO; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Overview

Background

Thoracentesis (thoracocentesis) is a core procedural skill for hospitalists, critical care physicians, and emergency physicians. With proper training in both thoracentesis itself and the use of bedside ultrasonography, providers can perform this procedure safely and successfully. [1, 2] Before the procedure, bedside ultrasonography can be used to determine the presence and size of pleural effusions and to look for loculations. [3] During the procedure, it can be used in real time to facilitate anesthesia and then guide needle placement.

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Indications

Thoracentesis is indicated for the symptomatic treatment of large pleural effusions (see the images below) or for treatment of empyemas. It is also indicated for pleural effusions of any size that require diagnostic analysis. [4, 5, 6]

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Contraindications

There are no absolute contraindications for thoracentesis. Relative contraindications include the following:

  • Uncorrected bleeding diathesis
  • Chest wall cellulitis at the site of puncture
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Complications

Complication rates for thoracentesis performed by experienced clinicians are not available. However, data on complications that develop after thoracentesis performed by residents learning the procedure are available. [1, 7]

Major complications include the following:

Minor complications include the following:

  • Pain (22%)
  • Dry tap (13%)
  • Cough (11%)
  • Subcutaneous hematoma (2%)
  • Subcutaneous seroma (0.8%)
  • Vasovagal syncope
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Technical Considerations

A 2017 review of literature on preprocedure, intraprocedure, and postprocedure aspects of thoracentesis suggested the following [9] :

  • Preprocedure - Physician training and maintenance of skills (eg, simulation with direct observation); moderate coagulopathy (eg, international normalized ratio <3, platelet count >25,000/μL) and mechanical ventilation do not increase risk of postprocedural complications
  • Intraprocedure - Ultrasonography is associated with a lower risk of pneumothorax; pleural manometry can help identify nonexpanding lung and may reduce risk of reexpansion pulmonary edema
  • Postprocedure - Routine chest radiography is not warranted because bedside ultrasonography can identify pneumothorax
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