Background
Indications
Indications | Contraindications (relative) |
---|---|
Recurrent malignant pleural effusion Symptomatic patients caused by the effusions Massive transudative or exsudative pleural effusion Parapneumonic effusions Weaning from mechanical ventilation | Coagulopathy, thrombocytopenia Small to medium size pleural effusions in cardiac patients with more than moderate left ventricular dysfunction Pulmonary bullae Pulmonary, pleural or thoracic adhesions Loculated pleural effusion or empyema Recurrent pleural infections Skin infection over the chest tube insertion site |
Preparation and equipment
For the operator | Over the tray | Patient |
---|---|---|
Medical hat | Sterile drapes | Disinfection of puncture site |
Medical mask | Sterile towels | Sterile drapes |
Hand disinfection | Syringes (5–10 mL) | Informed consent (when possible) |
Sterile gown | Local anaesthetics | |
Sterile gloves | Sterile water | |
Phased array probe or convex and linear probe Sterile US probe cover | ||
Introducer needle | ||
Guidewire | ||
Scalpel and dilator | ||
Catheters (8–14F) | ||
Trocar | ||
Suture and medical dressing |
Ultrasound guidance
Identification of puncture site
Intercostal artery visualisation
Site marking or direct needle guidance
Advantage | Limitations |
---|---|
Can be performed in any position | Thickness of ribcage and soft tissues (i.e., obese patients) |
Identification of the best site of puncture and best safety margin | Subcutaneous emphysema or large thoracic dressings |
The procedure
Complications and side-effects
-
Pneumothorax;
-
Dry tap;
-
Subdiaphragmatic insertion (injury to the diaphragm, liver or spleen with significant haemorrhage);
-
Laceration of adjacent structures (pleural or cardiac laceration);
-
Intercostal artery laceration;
-
Catheter malposition;
-
Catheter dislodgement or kinking;
-
Catheter blockage;
-
Wound infection and empyema;
-
Re-expansion pulmonary edema.