Thoracentesis outcomes: A 12-year experience

Mark J. Ault, Bradley T. Rosen, Jordan Scher, Joe Feinglass, Jeffrey H. Barsuk*

*Corresponding author for this work

Research output: Contribution to journalArticle

51 Citations (Scopus)

Abstract

Background: Despite a lack of evidence in the literature, several assumptions exist about the safety of thoracentesis in clinical guidelines and practice patterns. We aimed to evaluate specific demographic and clinical factors that have been commonly associated with complications such as iatrogenic pneumothorax, reexpansion pulmonary oedema (REPE) and bleeding. Methods: We performed a cohort study of inpatients who underwent thoracenteses at Cedars-Sinai Medical Center (CSMC) from August 2001 to October 2013. Data were collected prospectively including information on volume of fluid removed, procedure side, whether the patient was on positive pressure ventilation, number of needle passes and supine positioning. Iatrogenic pneumothorax, REPE and bleeding were tracked for 24 h after the procedure or until a clinical question was reconciled. Demographic and clinical characteristics were obtained through query of electronic medical records. Results: CSMC performed 9320 inpatient thoracenteses on 4618 patients during the study period. There were 57 (0.61%) iatrogenic pneumothoraces, 10 (0.01%) incidents of REPE and 17 (0.18%) bleeding episodes. Iatrogenic pneumothorax was significantly associated with removal of >1500 mL fluid (p<0.0001), unilateral procedures (p=0.001) and more than one needle pass through the skin (p=0.001). For every 1 mL of fluid removed there was a 0.18% increased risk of REPE (95% CI 0.09% to 0.26%). There were no significant associations between bleeding and demographic or clinical variables including International Normalised Ratio, partial thromboplastin time and platelet counts. Conclusions: Our series of thoracenteses had a very low complication rate. Current clinical guidelines and practice patterns may not reflect evidence-based best practices.

Original languageEnglish (US)
Pages (from-to)127-132
Number of pages6
JournalThorax
Volume70
Issue number2
DOIs
StatePublished - Feb 1 2015

Fingerprint

compound A 12
Pneumothorax
Pulmonary Edema
Physicians' Practice Patterns
Hemorrhage
Demography
Needles
Inpatients
Guidelines
International Normalized Ratio
Partial Thromboplastin Time
Positive-Pressure Respiration
Electronic Health Records
Evidence-Based Practice
Platelet Count
Practice Guidelines
Cohort Studies
Safety
Skin
Thoracentesis

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Ault, Mark J. ; Rosen, Bradley T. ; Scher, Jordan ; Feinglass, Joe ; Barsuk, Jeffrey H. / Thoracentesis outcomes : A 12-year experience. In: Thorax. 2015 ; Vol. 70, No. 2. pp. 127-132.
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abstract = "Background: Despite a lack of evidence in the literature, several assumptions exist about the safety of thoracentesis in clinical guidelines and practice patterns. We aimed to evaluate specific demographic and clinical factors that have been commonly associated with complications such as iatrogenic pneumothorax, reexpansion pulmonary oedema (REPE) and bleeding. Methods: We performed a cohort study of inpatients who underwent thoracenteses at Cedars-Sinai Medical Center (CSMC) from August 2001 to October 2013. Data were collected prospectively including information on volume of fluid removed, procedure side, whether the patient was on positive pressure ventilation, number of needle passes and supine positioning. Iatrogenic pneumothorax, REPE and bleeding were tracked for 24 h after the procedure or until a clinical question was reconciled. Demographic and clinical characteristics were obtained through query of electronic medical records. Results: CSMC performed 9320 inpatient thoracenteses on 4618 patients during the study period. There were 57 (0.61{\%}) iatrogenic pneumothoraces, 10 (0.01{\%}) incidents of REPE and 17 (0.18{\%}) bleeding episodes. Iatrogenic pneumothorax was significantly associated with removal of >1500 mL fluid (p<0.0001), unilateral procedures (p=0.001) and more than one needle pass through the skin (p=0.001). For every 1 mL of fluid removed there was a 0.18{\%} increased risk of REPE (95{\%} CI 0.09{\%} to 0.26{\%}). There were no significant associations between bleeding and demographic or clinical variables including International Normalised Ratio, partial thromboplastin time and platelet counts. Conclusions: Our series of thoracenteses had a very low complication rate. Current clinical guidelines and practice patterns may not reflect evidence-based best practices.",
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Thoracentesis outcomes : A 12-year experience. / Ault, Mark J.; Rosen, Bradley T.; Scher, Jordan; Feinglass, Joe; Barsuk, Jeffrey H.

In: Thorax, Vol. 70, No. 2, 01.02.2015, p. 127-132.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Thoracentesis outcomes

T2 - A 12-year experience

AU - Ault, Mark J.

AU - Rosen, Bradley T.

AU - Scher, Jordan

AU - Feinglass, Joe

AU - Barsuk, Jeffrey H.

PY - 2015/2/1

Y1 - 2015/2/1

N2 - Background: Despite a lack of evidence in the literature, several assumptions exist about the safety of thoracentesis in clinical guidelines and practice patterns. We aimed to evaluate specific demographic and clinical factors that have been commonly associated with complications such as iatrogenic pneumothorax, reexpansion pulmonary oedema (REPE) and bleeding. Methods: We performed a cohort study of inpatients who underwent thoracenteses at Cedars-Sinai Medical Center (CSMC) from August 2001 to October 2013. Data were collected prospectively including information on volume of fluid removed, procedure side, whether the patient was on positive pressure ventilation, number of needle passes and supine positioning. Iatrogenic pneumothorax, REPE and bleeding were tracked for 24 h after the procedure or until a clinical question was reconciled. Demographic and clinical characteristics were obtained through query of electronic medical records. Results: CSMC performed 9320 inpatient thoracenteses on 4618 patients during the study period. There were 57 (0.61%) iatrogenic pneumothoraces, 10 (0.01%) incidents of REPE and 17 (0.18%) bleeding episodes. Iatrogenic pneumothorax was significantly associated with removal of >1500 mL fluid (p<0.0001), unilateral procedures (p=0.001) and more than one needle pass through the skin (p=0.001). For every 1 mL of fluid removed there was a 0.18% increased risk of REPE (95% CI 0.09% to 0.26%). There were no significant associations between bleeding and demographic or clinical variables including International Normalised Ratio, partial thromboplastin time and platelet counts. Conclusions: Our series of thoracenteses had a very low complication rate. Current clinical guidelines and practice patterns may not reflect evidence-based best practices.

AB - Background: Despite a lack of evidence in the literature, several assumptions exist about the safety of thoracentesis in clinical guidelines and practice patterns. We aimed to evaluate specific demographic and clinical factors that have been commonly associated with complications such as iatrogenic pneumothorax, reexpansion pulmonary oedema (REPE) and bleeding. Methods: We performed a cohort study of inpatients who underwent thoracenteses at Cedars-Sinai Medical Center (CSMC) from August 2001 to October 2013. Data were collected prospectively including information on volume of fluid removed, procedure side, whether the patient was on positive pressure ventilation, number of needle passes and supine positioning. Iatrogenic pneumothorax, REPE and bleeding were tracked for 24 h after the procedure or until a clinical question was reconciled. Demographic and clinical characteristics were obtained through query of electronic medical records. Results: CSMC performed 9320 inpatient thoracenteses on 4618 patients during the study period. There were 57 (0.61%) iatrogenic pneumothoraces, 10 (0.01%) incidents of REPE and 17 (0.18%) bleeding episodes. Iatrogenic pneumothorax was significantly associated with removal of >1500 mL fluid (p<0.0001), unilateral procedures (p=0.001) and more than one needle pass through the skin (p=0.001). For every 1 mL of fluid removed there was a 0.18% increased risk of REPE (95% CI 0.09% to 0.26%). There were no significant associations between bleeding and demographic or clinical variables including International Normalised Ratio, partial thromboplastin time and platelet counts. Conclusions: Our series of thoracenteses had a very low complication rate. Current clinical guidelines and practice patterns may not reflect evidence-based best practices.

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JF - Thorax

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