PURPOSE: This retrospective chart review was undertaken to determine the overall complication rate of thoracentesis, to compare the rate of complications (specifically the rate of pneumothorax) between bedside and ultrasound guided thoracentesis, and to document which tests are commonly requested for pleural fluid analysis. Our hypothesis was that ultrasound guidance reduces the risk of thoracentesis-associated pneumothorax.
METHODS: We reviewed all charts of patients admitted to Royal University Hospital between September 2008 and September 2010 who underwent thoracentesis. Complications were defined as radiologic evidence of pneumothorax on post-thoracentesis imaging, or mention of bleeding, infection, or dyspnea on procedure notes, progress notes, or discharge summaries.
RESULTS: The overall rate of pneumothorax was 2.9%. Pneumothorax occurred in 0 of 97 procedures performed with ultrasound, and in 5 of 74 (6.8%) procedures performed without. One patient developed re-expansion pulmonary edema following an ultrasound-guided thoracentesis (fluid removed = 2100 mLs). We documented significant variability in what diagnostic tests were ordered for pleural fluid analysis and in what diagnostic tests were actually performed.
CONCLUSIONS: Our data confirms our hypothesis that ultrasound guidance reduces the risk of pneumothorax associated with thoracentesis.
CLINICAL IMPLICATIONS: Our data suggests that ultrasonography does improve thoracentesis safety by reducing the incidence of pneumothorax. Further studies should be undertaken to determine if this benefit is limited to procedures performed by radiologists, or if the benefits can be extended to bedside ultrasound-guided thoracentesis as well. Additionally, the variability in what tests are ordered and ultimately performed for pleural fluid analysis suggests that standardized pleural fluid analysis orders should be implemented to ensure all appropriate investigations are obtained when indicated, and to reduce the potential occurrence of repeated invasive diagnostic procedures.
DISCLOSURE: The following authors have nothing to disclose: Nathan Janzen, Richard Nataraj, Chris Hergott, Darcy Marciniuk
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