Modified thoracentesis technique using a triple-lumen catheter

Therapeutic thoracentesis may be preferable over tube thoracostomy in select clinical scenarios in which a symptomatic pleural effusion develops after an isolated and limited physiologic insult. Notable risks in patients undergoing bedside thoracentesis include parenchymal lung injury, abdominal organ injury, and incomplete pleural drainage. These risks are driven in part by inexperienced house officers performing the technique, coupled with technical limitations imparted by hospital-provided thoracentesis kits. To address these concerns, we present a modification to the technique of bedside thoracentesis whereby a triple-lumen catheter is placed into the pleural space over a guidewire. This approach overcomes shortcomings of the packaged thoracentesis kits, improves patient comfort, minimizes the risk of lung injury, and provides more complete drainage of the pleural cavity in patients requiring therapeutic thoracentesis. This approach carries a small risk of air entry into the pleural space, which can be minimized with meticulous technique. Furthermore, by using a Seldinger approach, our technique can improve resident comfort with thoracentesis by drawing on a more robust skill set that likely already has developed during their training in central line placement.