Procedure - Thoracentesis

Question 1

Thoracentesis is contraindicated in what two lab abnormalities?

Answer 1

Platelets less than 50 or INR greater than 2

Question 2

What criteria give you exudative vs transudative pleural effusions?

Answer 2

Light criteria – any one positive for exudate is exudative

• Fluid:serum protein > 0.5
• Fluid:serum LDH > 0.6
• LDH > 2/3 UPL

Remember that “LDH” and “SIX” have three letters, which can help you remember which serum value is > 0.6.

Question 3

What landmarks demarcate the axillae?

Answer 3

Anterior: pectus major
Posterior: latissimus dorsi
Inferior: nipple line

Question 4

When you use US to guide your thoracentesis, be sure that you ______________.

Answer 4

find a spot that is safe to insert a needle in both expiration and inspiration

Question 5

What is the maximum volume of fluid that can safely be removed?

Answer 5

There is no upper limit. It was previously taught that 1,500 mL was the max, but studies have since shown that as long as patients remain asymptomatic you can safely remove more.

Question 6

In general, you should insert the needle where for a thoracentesis?

Answer 6

Have the patient sit upright and then use ultrasound to find the height of the effusion. Insert 5-10 cm lateral to the spine, 1-2 intercostal spaces below the height of the effusion.

Question 7

What is the most inferior spot you can go in a thoracentesis?

Answer 7

Between ribs 8 and 9