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.