Pulmonology Book

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Thoracentesis

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  1. See Also
    1. Pleural Effusion
    2. Pleural Effusion Causes
    3. Pleural Fluid Interpretation
  2. Indications
    1. Effusion >10 mm thick
      1. Based on lateral decubitus XRay or Ultrasound
    2. Effusion not explained by other cause
      1. CHF not responding within 3 days to diuresis
      2. Asymmetric Pleural Effusions
      3. Fever
  3. Safety
    1. Ultrasound-guided thoracentesis has less complications
      1. Jones (2003) Chest 123:418
  4. 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
  5. 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
  6. Precautions
    1. Limit fluid removal to 1500 cc
  7. Follow-up: Post-procedure Chest XRay Indications
    1. Post-procedure symptoms (Chest Pain, Dyspnea)
    2. Signs of Pneumothorax post-procedure
      1. Voice transmission absent superior to thoracentesis
      2. Tactile fremitus absent superior to thoracentesis
  8. Interpretation
    1. See Thoracentesis Interpretation
    2. See Pleural Effusion Causes

Thoracentesis (C0189477)

Definition (NCI)(thor-a-sen-TEE-sis) Removal of fluid from the pleural cavity through a needle inserted between the ribs.
ConceptsDiagnostic Procedure (T060) , Therapeutic or Preventive Procedure (T061)
ICD934.91
EnglishChest aspiration, Paracentesis of chest, Pleural aspiration, Pleural cavity tap, Pleural tap, Pleurocentesis, Puncture of Pleural Cavity for Aspiration, Thoracentesis, Thoracic paracentesis, Thoracocentesis
Spanishpleurocentesis, puncion del espacio pleural para aspiracion, toracocentesis
Parent ConceptsParacentesis (C0034115), Incision of pleura; thoracentesis; chest drainage (C0810121), Body part (C0229962), Other thorax operations (C0175584), Thoracic Surgical Procedures (C0524832), Non-thoracoscopic percutaneous pleural puncture procedure (C0405998), Procedure on pleural cavity (C1292962), Duplicate concept (C1274013)
SourcesAOD, CCS, HL7V2.5, ICD9CM, MTHCH, NCI, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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