Inspired by Dr. Schuberg’s outstanding procedural skillz this week, I present the thoracentesis:
Indications: Suspected pleural space infection, new effusion without diagnosis, and relief of dyspnea caused by large effusion
Contraindications: severe clotting abnormality (relative)
Complications: Ptx, cough, infection, hemothorax, re-expansion pulmonary edema, air embolism.
Technique: No specific technique has been shown to be superior to another, however its 2016 and ultrasound is available and has been show to reduce complication rates, so you should probably use it. Generally the patient should be seated upright, leaning on a mayo stand. The procedure may be performed with a standard 21-gauge needle, three-way stopcock and a syringe, but generally a commercial kit is used when available. Refer to the below diagram from Robert’s and Hedges’ for more insight
Alder, EH. Blok BK. Thoracentesis. Roberts and Hedges’ Clinical Procedures in Emergency Medicine, Chapter 9, 173-188.e1