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.
- 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)
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