Thursday, February 11, 2010


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1. Pneumothorax: There are two types of pneumothoraxes which can follow a Thoracentesis.

The first one is secondary to the introduction of air from the outside. This is benign and does not give rise to any symptoms. It should be left alone.

The second type of Pneumothorax occurs due to an accidental puncture of the lung. If the patient is asymptomatic, keep him under observation and follow the patient's progress with a serial chest x-ray. Usually, the puncture in the lung seals and air will be absorbed spontaneously. If the patient is symptomatic, chest tube drainage may be necessary.
2. Hemothorax: Bleeding is a possibility during a Thoracentesis. Fortunately, this is rare. Injury to an intercostal artery is fortunately rare since physicians seem to be aware of their location and avoid it during Thoracentesis.
3. Vaso-Vagal Syncope
4. Empyema Empyema is a dreaded complication. Follow strict surgical aseptic techniques to avoid it.
5. Laceration of the Liver or Spleen
6. Tumor Seeding Implantation of tumor cells through a Thoracentesis needle track is an infrequent complication. This occurs with a high degree of frequency in patients with Mesothelioma and may pose problems. However, with other tumors, it is of little significance.
7. Pain Pain during the procedure is due to poor technique in the use of a local anesthetic. Occasionally you may encounter a patient who is so high strung that even touching him may cause pain! Try premedication and reassurance if this should be the case. Mild pain is to be anticipated for 24 hours after the procedure. If the patient complains of shoulder pain during the procedure, it indicates that the needle is piercing the diaphragmatic pleura. The site of the tap is too low.
8. Extravasation of Fluid
Subcutaneous Seroma: If the fluid is under tension, extravasation can occur along the needle track to the subcutaneous tissue. In some patients, this is massive, disfiguring chest and abdominal wall. Anticipate this complication in massive effusions, particularly when the fluid spurts out or fills the syringe forcefully during the Thoracentesis. You may want to release the pressure by evacuating some fluid and following it up with a firm pressure bandage. Should this occur, reassure the patient. Usually, it gets reabsorbed in a matter of days.
9.Reexpansion pulmonary edema. As such, therapeutic thoracentesis is one of the most commonly performed medical procedures. Although complete drainage is generally desirable to maximize the improvement in a patient’s symptoms, to minimize the potential for subsequent procedures, to predict the success of pleurodesis for malignant pleural effusions, and to optimize postdrainage chest imaging, expert consensus suggests limiting drainage in one setting to 1 L to avoid reexpansion pulmonary edema (RPE) .

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