Thoracentesis

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 123:418-23
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