Safe and effective bedside thoracentesis

A review of the evidence for practicing clinicians

Richard J. Schildhouse*, Andrew Lai, Jeffrey H Barsuk, Michelle Mourad, Vineet Chopra

*Corresponding author for this work

Research output: Contribution to journalReview article

4 Citations (Scopus)

Abstract

BACKGROUND: Physicians often care for patients with pleural effusion, a condition that requires thoracentesis for evaluation and treatment. We aim to identify the most recent advances related to safe and effective performance of thoracentesis. METHODS: We performed a narrative review with a systematic search of the literature. Two authors independently reviewed search results and selected studies based on relevance to thoracentesis; disagreements were resolved by consensus. Articles were categorized as those related to the pre-, intra- and postprocedural aspects of thoracentesis. RESULTS: Sixty relevant studies were identified and included. Pre-procedural topics included methods for physician training and maintenance of skills, such as simulation with direct observation. Additionally, pre-procedural topics included the finding that moderate coagulopathies (international normalized ratio less than 3 or a platelet count greater than 25,000/μL) and mechanical ventilation did not increase risk of postprocedural complications. Intraprocedurally, ultrasound use was associated with lower risk of pneumothora, while pleural manometry can identify a nonexpanding lung and may help reduce risk of re-expansion pulmonary edema. Postprocedurally, studies indicate that routine chest X-ray is unwarranted, because bedside ultrasound can identify pneumothorax. CONCLUSIONS: While the performance of thoracentesis is not without risk, clinicians can incorporate recent advances into practice to mitigate patient harm and improve effectiveness.

Original languageEnglish (US)
Pages (from-to)266-276
Number of pages11
JournalJournal of hospital medicine
Volume12
Issue number4
DOIs
StatePublished - Apr 1 2017

Fingerprint

Patient Harm
Physicians
International Normalized Ratio
Manometry
Pneumothorax
Pulmonary Edema
Pleural Effusion
Platelet Count
Artificial Respiration
Patient Care
Thorax
Maintenance
Observation
X-Rays
Thoracentesis
Lung
Therapeutics

ASJC Scopus subject areas

  • Leadership and Management
  • Fundamentals and skills
  • Health Policy
  • Care Planning
  • Assessment and Diagnosis

Cite this

Schildhouse, Richard J. ; Lai, Andrew ; Barsuk, Jeffrey H ; Mourad, Michelle ; Chopra, Vineet. / Safe and effective bedside thoracentesis : A review of the evidence for practicing clinicians. In: Journal of hospital medicine. 2017 ; Vol. 12, No. 4. pp. 266-276.
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abstract = "BACKGROUND: Physicians often care for patients with pleural effusion, a condition that requires thoracentesis for evaluation and treatment. We aim to identify the most recent advances related to safe and effective performance of thoracentesis. METHODS: We performed a narrative review with a systematic search of the literature. Two authors independently reviewed search results and selected studies based on relevance to thoracentesis; disagreements were resolved by consensus. Articles were categorized as those related to the pre-, intra- and postprocedural aspects of thoracentesis. RESULTS: Sixty relevant studies were identified and included. Pre-procedural topics included methods for physician training and maintenance of skills, such as simulation with direct observation. Additionally, pre-procedural topics included the finding that moderate coagulopathies (international normalized ratio less than 3 or a platelet count greater than 25,000/μL) and mechanical ventilation did not increase risk of postprocedural complications. Intraprocedurally, ultrasound use was associated with lower risk of pneumothora, while pleural manometry can identify a nonexpanding lung and may help reduce risk of re-expansion pulmonary edema. Postprocedurally, studies indicate that routine chest X-ray is unwarranted, because bedside ultrasound can identify pneumothorax. CONCLUSIONS: While the performance of thoracentesis is not without risk, clinicians can incorporate recent advances into practice to mitigate patient harm and improve effectiveness.",
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Safe and effective bedside thoracentesis : A review of the evidence for practicing clinicians. / Schildhouse, Richard J.; Lai, Andrew; Barsuk, Jeffrey H; Mourad, Michelle; Chopra, Vineet.

In: Journal of hospital medicine, Vol. 12, No. 4, 01.04.2017, p. 266-276.

Research output: Contribution to journalReview article

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N2 - BACKGROUND: Physicians often care for patients with pleural effusion, a condition that requires thoracentesis for evaluation and treatment. We aim to identify the most recent advances related to safe and effective performance of thoracentesis. METHODS: We performed a narrative review with a systematic search of the literature. Two authors independently reviewed search results and selected studies based on relevance to thoracentesis; disagreements were resolved by consensus. Articles were categorized as those related to the pre-, intra- and postprocedural aspects of thoracentesis. RESULTS: Sixty relevant studies were identified and included. Pre-procedural topics included methods for physician training and maintenance of skills, such as simulation with direct observation. Additionally, pre-procedural topics included the finding that moderate coagulopathies (international normalized ratio less than 3 or a platelet count greater than 25,000/μL) and mechanical ventilation did not increase risk of postprocedural complications. Intraprocedurally, ultrasound use was associated with lower risk of pneumothora, while pleural manometry can identify a nonexpanding lung and may help reduce risk of re-expansion pulmonary edema. Postprocedurally, studies indicate that routine chest X-ray is unwarranted, because bedside ultrasound can identify pneumothorax. CONCLUSIONS: While the performance of thoracentesis is not without risk, clinicians can incorporate recent advances into practice to mitigate patient harm and improve effectiveness.

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