Complications Associated with Thoracocentesis

doi:10.1378/chest.90.1.97

Chest

Volume 90, Issue 1, July 1986, Pages 97-100

https://doi.org/10.1378/chest.90.1.97 Get rights and content

In order to determine the spectrum and frequency of complications associated with thoracocentesis, we decided to audit prospectively all thoracocenteses performed in the medical service at our institution. Over a ten-month interval, 125 procedures were performed. We identified 114 (91 percent) prospectively, 11 retrospectively by a computerassisted review of discharge summaries. Forty-six percent of the procedures were complicated by at least one adverse occurrence. Complications considered major occurred in 14 percent, minor in 33 percent. The major complications included 14 pneumothoraces (three required tube thoracostomies and one percutaneous aspiration), one splenic laceration, one sheared-off catheter, and one pneumo-hemothorax. The minor complications included pain in 28, persistent cough in 14, dry taps in 16, and subcutaneous fluid collections in four patients. We conclude that thoracocentesis can carry the risk of frequent morbidity even when a lecture and printed guidelines on performing thoracocentesis have been given and experienced individuals are in attendance during the performance of the procedure. Our study suggests a portion of this morbidity may be from poor technique, inability to adequately identify landmarks, and improper utilization of a needle-catheter apparatus. Suggestions for correction of these problems are made.

Section snippets

MATERIALS AND METHODS

In order to accomplish our goal, we designed a prospective audit. First, all medical house officers were notified when the study was to begin and that each procedure would be concurrently audited. They were asked to write a detailed procedure note that included a description of the procedure, the indication, the equipment used, the anesthesia used, the position of the patient during the procedure, the location of the thoracocentesis by interspace, the amount and character of the fluid obtained,

RESULTS

During a ten month period of time, 125 thoracocenteses were performed on 91 patients in our medical service, which served as our data base. Of the 125 procedures, 114 (91 percent) were prospectively identified, while an additional 11 (9 percent) were retrospectively identified by computer review. Of the 91 patients, 70 (77 percent) were concurrently and independently interviewed and examined. Out of the 125 procedures, 112 (90 percent) were performed at the bedside by house officers, two after

DISCUSSION

By prospectively designing a study to audit the spectrum and frequency of complications associated with the performance of thoracocentesis in a university teaching hospital, we determined that thoracocentesis can carry the risk of frequent morbidity. The overall complication rate, including minor as well as major complications, was 46 percent. Pneumothorax occurred in 11 percent. Although we were initially surprised at the apparent high frequency and severity of the complications associated

ACKNOWLEDGMENT

The authors thank Bonnie J. Cazeault for secretarial assistance.

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Presented in part at the 50th Annual Meeting, American College of Chest Physicians, Dallas, TX, October 8-12, 1984.

Manuscript received November 11; revision accepted December 30.

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