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
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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

  • 0.61% of iatrogenic pneumothoraces
  • 0.01% rate of re-expansion pulmonary edema
  • 0.18% of bleeding episodes

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.