L6: Procedures Flashcards
Indications for thoracocentesis
Transudative or exudative
Relieve pain, dyspnea
Allow for better radiographic imaging of lung
Establish infectious, inflammatory, or malignant process
Contraindications for thoracocentesis
Significant thrombocytopenia
Do not remove >1L or perform bilateral → re-expansion pulmonary edema
Complications of thoracocentesis
Pneumothorax Intrapleural bleeding Hemoptysis Reflex bradycardia and hypotension Tumor seeding Empyema (pus) Re-expansion pulmonary edema
When to sample pleural fluid
If layers out >25 mm on lateral decubitus film
loculated
associated with thickened parietal pleura on CT
clearly delineated by ultrasound
Imaging prior to thoracocentesis
CXR PA, lateral, lateral decubitus: check that it is accessible by needle aspiration, check for fluidity: “layers out” in lateral decubitus
+/- Ultrasound: localize fluid
+/- CT with contrast: more detail
Indications for Abdominal Paracentesis
ALL new onset ascites with or without:
Fever, abdominal tenderness (spontaneous bacterial peritonitis), mental status change, hypotension, peripheral leukocytosis, worsening renal function, trauma/severe cirrhosis (r/o intra-abdominal bleed)
Imaging prior to Abdominal Paracentesis
Gold standard=Abdominal Ultrasound
CT or MRI for further evaluation of malignancy
Contraindictations to Abdominal Paracentesis
Coagulation abnormalities
Patients with a small amount of fluid
Previous abdominal surgeries
Hepatosplenomegaly
Complications of Abdominal Paracentesis
Large amount removed→ fluid re-accumulates from intravascular volume→ hypovolemia
Hepatic coma in patient with chronic liver disease
Peritonitis
Tumor seeding with malignant ascites
Hepatosplenomegaly→ organ perforation
Water bottle sign
seen on CXR of pericardial effusion
Indications for pericardiocentesis
Not usually required
Therapeutic
Pericardial effusion + tamponade
Diagnostic
Fluid needed for diagnosis
Diagnosis might change management (malignancy)`
Contraindications to pericardiocentesis
Pericarditis without effusion
Effusion + stable + source known → treat with follow up echo
Coagulopathy (caution)
Uncooperative patients
Complications of pericardiocentesis
Laceration of coronary artery Puncture of myocardium Dysrhythmias MI Pneumothorax Vasovagal hypotension Pleural/pericardial infection
Lumbar puncture indications
Infection: Meningitis (bacterial, fungal, viral, parasitic), Encephalitis, Abscesses, Neurosyphilis
Malignancy: primary or metastatic brain tumor, spinal cord neoplasms
Multiple sclerosis
Cerebral/subarachnoid hemorrhage
Lumbar puncture contraindications
Increased intracranial pressure (ICP)
Severe vertebral degenerative joint disease
Infection near LP site
Anticoagulants
