II. Indications

  1. Effusion >1 cm high on decubitus XRay in an undiagnosed patient
  2. Effusion >5 cm high on lateral XRay in Pneumonia patient (Parapneumonic Effusion, empyema)
  3. Ultrasound with pocket >1 cm (and no intervening tissue such as liver)
  4. Effusion not explained by other cause
    1. CHF not responding within 3 days to diuresis
    2. Asymmetric Pleural Effusions
    3. Fever
  5. Avoid Thoracentesis for suspected transudative bilateral Pleural Effusions
    1. Exception: Effusion not explained by other cause (see above)

III. Safety

  1. Ultrasound-guided Thoracentesis is associated with fewer complications
    1. Jones (2003) Chest 123:418-23 [PubMed]

IV. Contraindications

  1. Local cutaneous condition
  2. Severe Coagulopathy
    1. ProTime or Partial Thromboplastin Time twice normal
    2. Platelet Count <25,000
    3. Creatinine > 6 mg/dl
  3. Chest XRay with mediastinal shift toward effusion
    1. Suggests negative pleural pressure
    2. Suggests Bronchial obstruction
    3. Bronchoscopy recommended in these cases

V. Complications

  1. Pneumothorax (11%)
    1. Requires Chest Tube in 2%
    2. Increased risk in COPD
    3. Decreased risk with experienced clinician
    4. Decreased risk with Ultrasound Guidance
  2. Cough
  3. Chest Pain
  4. Vasovagal Syncope
  5. Infection (2%)
  6. Hemothorax

VI. Precautions

  1. Limit fluid removal to 1500 cc

VII. Follow-up: Post-procedure Chest XRay Indications

  1. Not required unless otherwise indicated by symptoms or signs of complication
  2. Post-procedure symptoms (Chest Pain, Dyspnea)
  3. Signs of Pneumothorax post-procedure
    1. Voice transmission absent superior to Thoracentesis
    2. Tactile fremitus absent superior to Thoracentesis

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Ontology: Thoracentesis (C0189477)

Definition (NCI_NCI-GLOSS) Removal of fluid from the pleural cavity through a needle inserted between the ribs.
Concepts Therapeutic or Preventive Procedure (T061) , Diagnostic Procedure (T060)
ICD9 34.91
SnomedCT 177818008, 150556002, 91602002
HL7 THORA
Italian Aspirazione della cavità pleurica, Toracentesi
Dutch pleuracentese, thoracocentese, pleuraholte aspiratie, aspiratie pleuraholte
French Pleuracentèse, Thoracentèse, Ponction de la cavité pleurale, Ponction pleurale
German Pleurazentese, Pleurahoehlenaspiration, Thorakozentese, Aspiration der Pleurahoehle
Portuguese Toracocentese, Pleurocentese, Aspiração da cavidade pleural
Spanish Pleuracentesis, Toracocentesis, pleurocentesis, punción del espacio pleural para aspiración, toracocentesis (procedimiento), toracocentesis, Aspiración de la cavidad pleural
Japanese 胸腔穿刺, 胸腔吸引, 胸膜穿刺, キョウマクセンシ, キョウクウセンシ, キョウクウキュウイン, キョコクウセンシ
Czech Punkce hrudníku, Punkce pleurálního výpotku, Aspirace z pleurální dutiny
English Aspiration pleural cavity, Pleural cavity aspiration, Pleuracentesis, pleural aspiration, pleurocentesis, pleural tap, thoracocentesis, thoracentesis, chest aspiration, procedure thoracentesis, Paracentesis of chest, Pleural aspiration (procedure), Pleurocentesis, Thoracentesis, Chest aspiration, Pleural aspiration, Pleural tap, Thoracic paracentesis, Thoracocentesis, Pleural cavity tap, Thoracentesis (procedure), Puncture of pleural cavity for aspiration, Chest Aspiration, Pleural Cavity Tap, Pleural Tap, Puncture of Pleural Cavity for Aspiration, Thoracic Paracentesis
Hungarian Pleuracentesis, Pleuralis üregi aspiratio, Pleuralis üreg aspiratio, Thoracentesis