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