LETTER
Simplified Bedside Thoracentesis
Bert Govig, MD, and
Marc Baltzan, MD
15 April 1994 | Volume 120 Issue 8 | Pages 695-696
TO THE EDITOR:
Although thoracentesis is generally considered to be well tolerated and safe, variations in the thoracentesis catheter, the need for ultrasound guidance, and the experience required of the person doing the procedure have all been questioned [1-4]. In our search for a safer method of thoracentesis, we have begun doing diagnostic thoracentesis using a Vacutainer (Becton-Dickinson, Rutherford, New Jersey) blood-taking apparatus in a manner similar to that used in blood taking. The prepared skin is penetrated with the needle, and suction is applied while the needle is still in the soft tissue. The needle is then advanced into the pleural space. This technique is advantageous in that it uses equipment that is readily available and familiar to almost all physicians, and it costs less than one tenth of the price of commercially prepared thoracentesis kits. It also provides less exposure to body fluids because specimens are collected directly into the appropriate test tube.
We retrospectively reviewed 26 consecutive diagnostic thoracenteses done using this technique. The technique was successful in 25 of 26 cases and on the first attempt in 24. More than 65% of patients found the procedure to be less painful than venipuncture. No pneumothoraces were detected on postprocedure inspiratory and expiratory chest radiographs. This finding compares favorably with pneumothorax rates quoted in the literature (4% to 30% combined diagnostic and therapuetic [1-4]) and with 6 of 85 (7%) diagnostic thoracenteses retrospectively reviewed in our hospital (unpublished data). Admittedly, the size and design of our study preclude rigorous comparisons.
To our knowledge, this simplified technique has never been described in the medical literature. It should be included in future studies assessing the safety and diagnostic utility of thoracentesis.
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Author and Article Information
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Sir Mortimer B. Davis Jewish General Hospital; Montreal, Quebec J9T-252; Canada
1. Bartter T, Mayo PD, Pratter MR, Santarelli RJ, Leeds WM, Akers SM. Lower risk and higher yield for thoracentesis when performed by experienced operators. Chest. 1993; 103:1873-6.
2. Grogan DR, Irwin RS, Channick R, Raptopoulos V, Curley FJ, Bartter T, et al. Complications associated with thoracentesis: a prospective, randomized study comparing three different methods. Arch Intern Med. 1990; 150:873-7.
3. Collins TR, Sahn SA. Thoracocentesis: clinical value, complications, technical problems, and patient experience. Chest. 1987; 91:817-22.
4. Seneff MG, Corwin RW, Gold LH, Irwin RS. Complications associated with thoracocentesis. Chest. 1986; 90:97-100.
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