pulmonary disorders
How To Do Thoracentesis
Additional Considerations for Thoracentesis
Thoracentesis can be safely done at the patient’s bedside or in an outpatient setting. Ample local anesthetic is necessary, but procedural sedation is not required in cooperative patients. Thoracentesis needle should not be inserted through infected skin (eg, cellulitis or herpes zoster). Positive pressure ventilation can increase the risk of complications. If the patient is receiving anticoagulant drugs (eg,warfarin), consider giving fresh frozen plasma or another reversal agent prior to the procedure. Hemorrhagic complications are infrequent after ultrasound-guided thoracentesis in patients with abnormal preprocedural coagulation parameters ( References ). Bloody fluid that does not clot in a collecting tube indicates that blood in the pleural space was not iatrogenic, because free blood in the pleural space rapidly defibrinates. Only unstable patients and patients at high risk of decompensation due to complications require monitoring (eg, pulse oximetry, electrocardiography [ECG]). 