Thoracentesis
Indications
- New-onset pleural effusion (except obvious CHF-induced effusion)
- Symptomatic pleural effusion
Relative Contraindications
- Plt <50K
- INR >2x normal
- Mechanical ventilation
Equipment Needed
- Thoracentesis kit
- Sterile gloves
- Chlorhexidine scrub
- Evacuated container
- 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
See Also
Source
- Robert and Hedges
- Tintinalli