16/09/2025
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🩺 Indications for Thoracocentesis
📌 Diagnostic Indications
– Unexplained pleural effusion
– Suspected infection (e.g., empyema, TB)
– Suspected malignancy
– Hemothorax or chylothorax
– Transudate vs exudate (Light’s criteria)
📌 Therapeutic Indications
– Relieve dyspnea from large effusion
– Drain pus or blood (empyema, hemothorax)
– Palliative drainage in malignancy
⚠️ Relative Contraindications
– Uncorrected coagulopathy
– Small or loculated effusions
– Mechanical ventilation (↑ pneumothorax risk)
🛠️ Thoracocentesis – Procedure (USG-Guided)
1. Position: Patient seated, leaning forward with arms supported
2. Site: Posterior/lateral chest, 1–2 spaces below fluid level
→ Always above the rib
3. Prep: Sterile technique + local anesthesia
4. Insert Needle/Catheter: Under ultrasound guidance
5. Aspirate Pleural Fluid: Slowly, avoid excessive removal
6. Sample: Send for biochemistry, microbiology, cytology
7. Post-procedure: Monitor vitals, check for pneumothorax (CXR if needed)
⚠️ Watch for:
– Pneumothorax
– Hemothorax
– Re-expansion pulmonary edema
– Infection
