■ Needle is inserted in second intercostal space, midclavicular line over
third rib to avoid nerve/vessel damage.
■ Rush of air will confirm placement, catheter, if used, can be advanced
over needle.
■ Attach to one-way drainage system to prevent pneumothorax reaccu-
mulation.
■ Sterile glove finger can be used as a one-way valve tied to needle at
one end with small hole on other end.
■ Evacuation of fluid: Posterior approach
■ Patient sitting upright:
■ 18- to 22-Ga needle is inserted at midscapular line or posterior axillary
line below the top of the fluid determined by percussion, but not below
eight intercostal space. Catheter (if used) is then advanced.
■ Patient supine with head elevated:
■ 18- to 22-Ga needle is inserted at midaxillary or posterior axillary
line in the fourth or fifth intercostal space.
COMPLICATIONS
■ Pneumothorax
■ Diaphragmatic, liver, intercostal nerve/vessel, or spleen injury
INTERPRETATION OFRESULTS
■ For diagnostic thoracentesis, send for LDH, glucose, protein, cell count,
and differential.
■ If needed, send for amylase, triglyceride level, cholesterol, complement,
RF, CEA, G-stain, cultures, AFB, fungal cultures, cytology, pH.
■ Exudate: Inflammation causing increased capillary permeability (pneumonia,
TB, CA, other)
■ Fluid/plasma protein >0.5
■ Fluid/plasma LDH >0.6
■ Fluid LDH >200 IU/mL
■ Fluid protein >3 g/dL
■ Specific gravity >1.016
■ Transudate: Ultrafiltrates of plasma through intact capillaries (CHF, cirrhosis,
hypoproteinemia, other)
■ Fluid/plasma protein <0.5
■ Fluid/plasma LDH <0.6
■ Fluid LDH <200 IU/mL
■ Fluid protein <3 g/dL
■ Specific gravity <1.016
Thoracostomy Tube
INDICATIONS
■ Pneumothorax
■ Hemothorax
■ Hemopneumothorax
CONTRAINDICATIONS
■ Relative:
■ Adhesions/blebs
■ Recurrent pneumothorax
■ Need for open thoracotomy
■ Bleeding diathesis
PROCEDURES AND SKILLS