Chest
Volume 91, Issue 6, June 1987, Pages 817-822
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Clinical Investigations
Thoracocentesis: Clinical Value, Complications, Technical Problems, and Patient Experience

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A prospective study of 129 consecutive thoracocenteses in 86 patients at a university medical center evaluated the clinical value, complications, and patient experience with thoracocentesis. Pleural fluid analysis in conjunction with the clinical presentation placed 78 pleural fluids into diagnostic categories: definitive 14 (18 percent), presumptive 44 (56 percent), and nondiagnostic 20 (26 percent). Fourteen of 78 (18 percent) of the nondiagnostic fluids were useful, while only six (8 percent) were not useful clinically; therefore, 92 percent of thoracocenteses provided clinically useful information. Using sequential data analysis, initial diagnostic categorizations of eight of 78 patients were upgraded from presumptive or nondiagnostic to definitive based on data available 24 hours following thoracocentesis. Thus, 70 patients were categorized based on the pleural fluid data obtained within the first 24 hours of thoracocentesis. Thirty-four objective complications occurred in 26 of 129 (20 percent) thoracocenteses. The most common complications were pneumothorax, 15 of 129 (12 percent), and cough, 12 of 129 (9 percent). Sixty-five subjective complications occurred in 56 of 123 (46 percent) thoracocenteses. Anxiety, 26 of 123 (21 percent), and site pain, 24 of 123 (20 percent), were the most common subjective complications noted. Thirty technical problems occurred in 129 (23 percent) thoracocenteses with blood contamination, 14 of 129 (11 percent), and dry tap, nine of 129 (7 percent), being the most common. We conclude that diagnostic thoracocentesis is a clinically valuable procedure if used in conjunction with the patient presentation with an understanding of its limitations for providing a specific etiologic diagnosis. When performed by physicians in training, the number of complications are substantial and the operator often underestimates the degree of patient discomfort. Awareness of the clinical value and complications of thoracocentesis should lead to improved use and safety of this procedure.

Section snippets

Data Collection

Information was collected by one author (T. R.C.) from consecutive patients undergoing thoracocentesis on medical services in one of three university affiliated hospitals served by the same housestaff who rotated among the three hospitals—The University of Colorado Health Sciences Center (UH), The Denver Veterans Hospital (VAH), and Denver General Hospital (DGH)—during the following periods: Sept-Oct 1981 (VAH), Jan-Feb 1982 (DGH), May-July 1982 (UH), Oct-Dec 1982 (UH), Jan-May 1983 (UH, VAH).

RESULTS

Eighty-six (86) patients underwent 129 thoracocenteses. There were 54 men and 32 women ranging in age from 22 to 96 years, with a mean age of 56.4 years. Thirty-five patients had two or more thoracocenteses. The ratio of number of patients to number of thoracocenteses from each hospital medical service was: University Hospital, 46/62; Veterans Hospital, 27/47; Denver General Hospital, 13/20. The reason for the first thoracocentesis performed on each patient was diagnostic only in 65 of 86 (76

DISCUSSION

Our results show that pleural fluid analysis can yield clinically useful information in greater than 90 percent of patients; however, the diagnostic usefulness of thoracocentesis is enhanced by understanding its limitations. A definitive etiologic diagnosis was made in 18 percent of our patients, a relatively low figure. Referral centers that might evaluate a population with a high incidence of malignancy have reported as high as 35 percent definitive diagnoses.6, 8 The major “diagnostic” value

ACKNOWLEDGMENTS

The authors wish to thank Drs. Richard Hamman and Gary Zerbe and the medical housestaff of the University of Colorado Health Science Center for their cooperation, Dr. John Heffner for helpful suggestions, and Leann Holst for secretarial assistance.

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    Presented in part at the Scientific Sessions of the American Federation for Clinical Research, Western Section, Carmel, CA, February 11, 1983, and American Thoracic Society, Kansas City, Kansas, May 10, 1983.

    Manuscript received August 7; revision accepted November 11.

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