THORACENTESIS IN CLINICAL-PRACTICE

Thoracentesis is a commonly performed procedure indicated for diagnost ic and therapeutic purposes. Removal of pleural fluid should be perfor med by experienced operators and, when attempted by physicians-in-trai ning, close supervision by credentialed individuals is necessary. Diag nostic thoracentesis is most valuable in separating exudates from tran sudates. Analysis of the exudative fluid has the highest yield when in fection and malignancy is likely. Pneumothorax is the most common majo r complication and can be minimized by the use of small-gauge needles (no. 21 or no. 22) when a small amount of fluid is removed (35 to 50 m l). Patients who may pose difficulties (e.g., those receiving ventilat or support) appear to have no greater morbidity with thoracentesis tha n those patients not ventilator dependent. Ultrasound may be of value to decrease morbidity when small or loculated volumes of fluid are pre sent. Therapeutic thoracentesis offers relief of symptoms of dyspnea, but caution is particularly needed because large needles and large vol umes of fluid removed may increase morbidity.