Pneumothorax and palliative pleural aspiration--an audit of technique

The incidence of pneumothorax following a review of 55 single-sitting bedside pleural aspirations of malignant effusions over an 18-month period in the clinical oncology departments of the Middlesex and Mount Vernon Hospitals was assessed and two groups were compared. Group 1 (29 aspirations in 16 patients) involved a technique using an 8 ch (French) gauge trocar and cannula, a three-way tap and a sealed bag system, resulting in no pneumothoraces. Group 2 (26 aspirations in 18 patients) involved a variety of other techniques with a pneumothorax rate of 19.2% (p = 0.0189 using Fisher's Exact Test). The small trocar/sealed bag system was complication-free, relatively painless, quick to perform, cheap, gave the option of draining to dryness and was easily learnt by the junior doctors who most often perform this procedure at the bedside. This technique is described in detail in the text. A reduction in the risk of pneumothorax minimizes the need for a postaspiration chest radiograph, facilitating aspiration in an outpatient, hospice or domiciliary setting. A domiciliary study is to be planned using the procedural standard described.