UMEM Educational Pearls

Category: Critical Care

Title: Safety of thoracentesis

Keywords: thoracentesis, pleural effusion, critical care (PubMed Search)

Posted: 5/4/2015 by Feras Khan, MD
Click here to contact Feras Khan, MD

Safety of Thoracentesis

Thoracentesis is routinely performed in both acute and non-acute patients while patients are admitted to the hospital for respiratory distress
A recent 12 year cohort study of 9320 thoracenteses was published from Cedars-Sinai Hospital
The clinicians that perform these procedures are well experienced
The most common complications include pneumothorax, re-expansion pulmonary edema, and bleeding

Results after 24 hours of followup post-procedure

Other interesting points:

Pneumothorax was associated with removing >1500 mL of fluid and more than one needle pass
Ultrasound was routinely used
A safety-tipped needle/catheter was used
Fluid was removed by manual hand pumping (not vacuum bottles)
CXR only done post-procedure if patients were symptomatic
No blood products were given for low platelets or thrombocytopenia

Bottom line: Use your ultrasound to direct your tap and dont take out more than 1500 mL routinely

Ault MJ et al. Thoracentesis outcomes: a 12-year experience. Thorax 2015;70:127-132.