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Ultrasound-guided thoracentesis: is it a safer method?
Phillip W Jones1, J Phillip Moyers, Jeffrey T Rogers
1Saint Thomas Hospital, and Vanderbilt University, Nashville, TN 37205, USA.
Chest
|February 11, 2003
Summary
Ultrasound-guided thoracentesis by interventional radiologists has a low complication rate, including rare vasovagal reactions without atropine and uncommon re-expansion pulmonary edema. This procedure is safe and effective for pleural fluid removal.
Area of Science:
- Medical Procedures
- Interventional Radiology
- Pulmonology
Background:
- Thoracentesis is a common procedure for pleural effusion management.
- Ultrasound guidance has become standard for improving safety and accuracy.
- Complication rates and predictive factors for adverse events require ongoing evaluation.
Purpose of the Study:
- To determine complication incidence from ultrasound-guided thoracentesis by interventional radiologists.
- To assess vasovagal event rates without atropine premedication.
- To identify factors predicting re-expansion pulmonary edema post-thoracentesis.
Main Methods:
- Prospective descriptive study conducted at a tertiary referral teaching hospital.
- Included 941 ultrasound-guided thoracenteses in 605 patients over three years.
- Data collected on complications, vasovagal reactions, and re-expansion pulmonary edema.
Main Results:
- Overall complication rate was low: pain (2.7%), pneumothorax (2.5%), shortness of breath (1.0%), vasovagal reaction (0.6%), re-expansion pulmonary edema (0.2%).
- Increased pneumothorax and pain incidence observed when >1,100 mL fluid removed (p < 0.05).
- Vasovagal reactions occurred in 0.6% without atropine; re-expansion pulmonary edema occurred in 0.5% when >1,000 mL fluid removed.
Conclusions:
- Ultrasound-guided thoracentesis by interventional radiologists demonstrates a lower complication rate than non-image-guided methods.
- Atropine premedication is unnecessary due to the low incidence of vasovagal reactions.
- Re-expansion pulmonary edema is uncommon, particularly when the procedure is stopped upon symptom development, even with large fluid volumes removed.