We need you! Join our contributor community and become a WikEM editor through our open and transparent promotion process.
Thoracentesis
From WikEM
Contents
Indications
- New-onset pleural effusion (except obvious CHF-induced effusion)
- Symptomatic pleural effusion
Contraindications
Thoracentesis if coagulopathic
Equipment Needed
- Thoracentesis kit
- Sterile gloves
- Chlorhexidine or betadine scrub
- Evacuated container
- Ultrasound
Procedure
- Choose insertion site/positioning
- Upright position in mid-scapular or posterior axillary line (usual technique)
- Lateral decubitus position with fluid side down in post axillary line (if cannot sit up)
- Supine with head elevated as much as possible in midaxillary line (chest tube location)
- Cleanse skin with chlorhexidine or betadine
- Anesthetize skin and subcutaneous tissue - raise wheal and advance/inject along superior aspect of lower rib (avoid NV bundle)
- Make small skin nick with scalpel
- Insert/advance needle while continuously aspirating until pleural space is entered
- Advance catheter into pleural space while removing needle
- Connect tubing to catheter and to evacuated container and remove desired amount of fluid
- Obtain post-procedure CXRif:
- Multiple needle passes required
- Air is aspirated
- Risk of adhesions
- New-onset of symptoms during the procedure (chest pain, dyspnea)
- Patient at high risk for decompensation from small pneumothorax (lung disease, positive pressure ventilation)
Complications
- Pneumothorax (4-19%)
- Cough (9%)
- Infection (2%)
- Hemothorax
- Splenic rupture
- Reexpansion pulmonary edema
- Dyspnea, tachypnea, cough, frothy sputum
- treatment with aggressive volume resuscitation
