Complications associated with thoracentesis. A prospective, randomized study comparing three different methods.
To determine what role the technique plays in complications associated with thoracentesis performed by physicians in training, we undertook a prospective study of thoracentesis in the medical service at our institution in which the sampling method was randomized among needle, needle with catheter, and needle with direct sonographic guidance. Fifty-two spontaneously breathing, cooperative patients with free-flowing effusions obliterating more than half of the hemidiaphragm on an upright, posteroanterior chest roentgenogram were randomized. When we analyzed those complications that were potentially life-threatening (eg, pneumothorax) and/or placed patients at increased risk for further morbidity (eg, pneumothorax, dry tap, inadequate tap), the sonography-guided method was associated with significantly fewer serious complications (0 of 19) than the needle-catheter (9 of 18) or needle-only methods (5 of 15). The sonography-guided method was associated with fewer pneumothoraces (0 of 19) than the needle-catheter (7 of 18) or needle-only methods (3 of 15). The difference between needle-catheter and needle-only methods was not significant. From our results, we conclude that the method by which thoracentesis was performed significantly influenced the spectrum and frequency of complications, and the sonography-guided method was the safest.
Grogan
D R
DR
Department of Medicine, University of Massachusetts Medical School, Worcester.
Irwin
R S
RS
Channick
R
R
Raptopoulos
V
V
Curley
F J
FJ
Bartter
T
T
Corwin
R W
RW
D002404:Catheterization / Q000295:instrumentation; D006406:Hematoma / Q000209:etiology; D006801:Humans; D009339:Needles; D010146:Pain / Q000209:etiology; D010996:Pleural Effusion / Q000175:diagnosis*; D011030:Pneumothorax / Q000209:etiology*; D011446:Prospective Studies; D011677:Punctures / Q000009:adverse effects* / Q000379:methods; D016032:Randomized Controlled Trials as Topic; D014463:Ultrasonography