First Things First

  • Thoracentesis is the invasive, percutaneous access of the pleural space for removal of pleural fluid or air.
  • As such, the procedure requires a written informed consent from the patient or his/her power of attorney.
  • Indications
  • Determine the diagnosis of the etiology of a pleural effusion: suspected infection, hemothorax, or empyema; effusion not explained by clinical presentation.
  • Provide therapeutic drainage of pleural effusion: large or massive effusion.
  • Absolute Contraindications
  • Severe hemodynamic and/or respiratory instability: treat/optimize before attempting thoracentesis.
  • Severe coagulopathy (platelet count <50,000; INR >1.5; fibrinogen <100)
  • Portal hypertension with coexisting pleural varices
  • Infection at the site of planned thoracentesis (i.e., varicella zoster, cellulitis)
  • Relative Contraindications
  • Mechanical ventilation with high level of PEEP (>10 cm H2O)
  • Presence of single lung (i.e., following pneumonectomy)
  • Small effusion (<1 cm on lateral decubitus CXR)

There's more to see -- the rest of this topic is available only to subscribers.

Last updated: May 5, 2010