Thoracentesis: Difference between revisions

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==Procedure==
==Procedure==
Routine [[ultrasonography]] can help obtain fluid samples and reduce complications according to [[randomized controlled trial]]s.<ref name="pmid3521416">{{cite journal |author=Kohan JM, Poe RH, Israel RH, ''et al'' |title=Value of chest ultrasonography versus decubitus roentgenography for thoracentesis |journal=Am. Rev. Respir. Dis. |volume=133 |issue=6 |pages=1124–6 |year=1986 |month=June |pmid=3521416 |doi= |url= |issn=}}</ref><ref name="pmid12576363">{{cite journal |author=Diacon AH, Brutsche MH, Solèr M |title=Accuracy of pleural puncture sites: a prospective comparison of clinical examination with ultrasound |journal=Chest |volume=123 |issue=2 |pages=436–41 |year=2003 |month=February |pmid=12576363 |doi= |url=http://www.chestjournal.org/cgi/pmidlookup?view=long&pmid=12576363 |issn=}}</ref><ref name="pmid2183735">{{cite journal |author=Grogan DR, Irwin RS, Channick R, ''et al'' |title=Complications associated with thoracentesis. A prospective, randomized study comparing three different methods |journal=Arch. Intern. Med. |volume=150 |issue=4 |pages=873–7 |year=1990 |month=April |pmid=2183735 |doi= |url= |issn=}}</ref>
Routine [[ultrasonography]] can help obtain fluid samples and reduce complications according to [[randomized controlled trial]]s<ref name="pmid3521416">{{cite journal |author=Kohan JM, Poe RH, Israel RH, ''et al'' |title=Value of chest ultrasonography versus decubitus roentgenography for thoracentesis |journal=Am. Rev. Respir. Dis. |volume=133 |issue=6 |pages=1124–6 |year=1986 |month=June |pmid=3521416 |doi= |url= |issn=}}</ref><ref name="pmid12576363">{{cite journal |author=Diacon AH, Brutsche MH, Solèr M |title=Accuracy of pleural puncture sites: a prospective comparison of clinical examination with ultrasound |journal=Chest |volume=123 |issue=2 |pages=436–41 |year=2003 |month=February |pmid=12576363 |doi= |url=http://www.chestjournal.org/cgi/pmidlookup?view=long&pmid=12576363 |issn=}}</ref><ref name="pmid2183735">{{cite journal |author=Grogan DR, Irwin RS, Channick R, ''et al'' |title=Complications associated with thoracentesis. A prospective, randomized study comparing three different methods |journal=Arch. Intern. Med. |volume=150 |issue=4 |pages=873–7 |year=1990 |month=April |pmid=2183735 |doi= |url= |issn=}}</ref> and a [[systematic review]].<ref name="pmid20177035">{{cite journal| author=Gordon CE, Feller-Kopman D, Balk EM, Smetana GW| title=Pneumothorax following thoracentesis: a systematic review and meta-analysis. | journal=Arch Intern Med | year= 2010 | volume= 170 | issue= 4 | pages= 332-9 | pmid=20177035
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&retmode=ref&cmd=prlinks&id=20177035 | doi=10.1001/archinternmed.2009.548 }} </ref>


The amount of fluid sent for cytology should be at least 60 mL if only direct smear/cytospin is used; whereas 150 mL should be sent if both direct smear/cytospin and cell block preparations are used.<ref name="pmid19741064">{{cite journal| author=Swiderek J, Morcos S, Donthireddy V, Surapaneni R, Jackson-Thompson V, Schultz L et al.| title=Prospective study to determine the volume of pleural fluid required to diagnose malignancy. | journal=Chest | year= 2010 | volume= 137 | issue= 1 | pages= 68-73 | pmid=19741064  
The amount of fluid sent for cytology should be at least 60 mL if only direct smear/cytospin is used; whereas 150 mL should be sent if both direct smear/cytospin and cell block preparations are used.<ref name="pmid19741064">{{cite journal| author=Swiderek J, Morcos S, Donthireddy V, Surapaneni R, Jackson-Thompson V, Schultz L et al.| title=Prospective study to determine the volume of pleural fluid required to diagnose malignancy. | journal=Chest | year= 2010 | volume= 137 | issue= 1 | pages= 68-73 | pmid=19741064  
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=19741064 | doi=10.1378/chest.09-0641 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref>
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=19741064 | doi=10.1378/chest.09-0641 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref>
Although an over-the-needle catheter is recommended by some experts<ref  name="pmid17035643">{{cite  journal |author=Thomsen TW, DeLaPena J, Setnik GS |title=Videos  in clinical medicine. Thoracentesis |journal=N. Engl. J. Med.  |volume=355 |issue=15 |pages=e16 |year=2006 |month=October  |pmid=17035643 |doi=10.1056/NEJMvcm053812 |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=17035643  |issn=}}</ref>, it does not clearly reduce the rate of pneumothorax.<ref name="pmid2183735">{{cite journal| author=Grogan DR, Irwin RS, Channick R, Raptopoulos V, Curley FJ, Bartter T et al.| title=Complications associated with thoracentesis. A prospective, randomized study comparing three different methods. | journal=Arch Intern Med | year= 1990 | volume= 150 | issue= 4 | pages= 873-7 | pmid=2183735
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&retmode=ref&cmd=prlinks&id=2183735 }} </ref>


==Complications==
==Complications==
The rote of [[pneumothorax]] is about 6%.<ref name="pmid20177035">{{cite journal| author=Gordon CE, Feller-Kopman D, Balk EM, Smetana GW| title=Pneumothorax following thoracentesis: a systematic review and meta-analysis. | journal=Arch Intern Med | year= 2010 | volume= 170 | issue= 4 | pages= 332-9 | pmid=20177035
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&retmode=ref&cmd=prlinks&id=20177035 | doi=10.1001/archinternmed.2009.548 }} </ref>
* [[Air embolism]]
* [[Air embolism]]
Correction of coagulopathy is not required.<ref name="pmid23493971">{{cite journal| author=Hibbert RM, Atwell TD, Lekah A, Patel MD, Carter RE, McDonald JS et al.| title=Safety of ultrasound-guided thoracentesis in patients with abnormal preprocedural coagulation parameters. | journal=Chest | year= 2013 | volume= 144 | issue= 2 | pages= 456-63 | pmid=23493971 | doi=10.1378/chest.12-2374 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23493971  }} </ref>


==References==
==References==

Revision as of 11:12, 14 September 2013

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A thoracentesis is an operative surgical procedure to " to remove fluid from the space between the lining of the outside of the lungs (pleura) and the wall of the chest."[1][2]

Procedure

Routine ultrasonography can help obtain fluid samples and reduce complications according to randomized controlled trials[3][4][5] and a systematic review.[6]

The amount of fluid sent for cytology should be at least 60 mL if only direct smear/cytospin is used; whereas 150 mL should be sent if both direct smear/cytospin and cell block preparations are used.[7]

Although an over-the-needle catheter is recommended by some experts[2], it does not clearly reduce the rate of pneumothorax.[5]

Complications

The rote of pneumothorax is about 6%.[6]

Correction of coagulopathy is not required.[8]

References

  1. ↑ MedlinePlus Medical Encyclopedia: Thoracentesis. National Library of Medicine. Retrieved on 2008-06-23.
  2. ↑ 2.0 2.1 Thomsen TW, DeLaPena J, Setnik GS (October 2006). "Videos in clinical medicine. Thoracentesis". N. Engl. J. Med. 355 (15): e16. DOI:10.1056/NEJMvcm053812. PMID 17035643. Research Blogging. Cite error: Invalid <ref> tag; name "pmid17035643" defined multiple times with different content
  3. ↑ Kohan JM, Poe RH, Israel RH, et al (June 1986). "Value of chest ultrasonography versus decubitus roentgenography for thoracentesis". Am. Rev. Respir. Dis. 133 (6): 1124–6. PMID 3521416. [e]
  4. ↑ Diacon AH, Brutsche MH, Solèr M (February 2003). "Accuracy of pleural puncture sites: a prospective comparison of clinical examination with ultrasound". Chest 123 (2): 436–41. PMID 12576363. [e]
  5. ↑ 5.0 5.1 Grogan DR, Irwin RS, Channick R, et al (April 1990). "Complications associated with thoracentesis. A prospective, randomized study comparing three different methods". Arch. Intern. Med. 150 (4): 873–7. PMID 2183735. [e] Cite error: Invalid <ref> tag; name "pmid2183735" defined multiple times with different content
  6. ↑ 6.0 6.1 Gordon CE, Feller-Kopman D, Balk EM, Smetana GW (2010). "Pneumothorax following thoracentesis: a systematic review and meta-analysis.". Arch Intern Med 170 (4): 332-9. DOI:10.1001/archinternmed.2009.548. PMID 20177035. Research Blogging.
  7. ↑ Swiderek J, Morcos S, Donthireddy V, Surapaneni R, Jackson-Thompson V, Schultz L et al. (2010). "Prospective study to determine the volume of pleural fluid required to diagnose malignancy.". Chest 137 (1): 68-73. DOI:10.1378/chest.09-0641. PMID 19741064. Research Blogging.
  8. ↑ Hibbert RM, Atwell TD, Lekah A, Patel MD, Carter RE, McDonald JS et al. (2013). "Safety of ultrasound-guided thoracentesis in patients with abnormal preprocedural coagulation parameters.". Chest 144 (2): 456-63. DOI:10.1378/chest.12-2374. PMID 23493971. Research Blogging.

External links

Thoracentesis - Information for patients from MedlinePlus (United States National Library of Medicine).

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