Thoracentesis Contraindications

December 29, 2016

Thoracentesis is a safest surgery by which excessive pleural fluid can be ejected from lungs. This procedure is recommended in many patients who are hospitalized and in emergency condition. It is indicated in many pathological conditions related to lungs and associated organs. Patients with breathing difficulty are mostly recommended Thoracentesis because excessive pleural fluid suppress lungs and breathing process. Like it has many indications, it also have some contraindications. It is strictly prohibited in some patients with certain pathological conditions. There are some non absolute Thoracentesis contraindications in which patient have to avoid this procedure. These non absolute Thoracentesis contraindications involve:

  • Bleeding diathesis (in this condition the coagulation capacity of blood is lost due to coagulopathy and blood bleeds more than usual in case of any injury). Patient with bleeding diathesis should avoid Thoracentesis because needle puncturing will lead to excessive bleeding.
  • When there is small effusion, then Thoracentesis is contraindicated. 
  • In case of mechanical ventilation, Thoracentesis is contraindicated because of high risk profile. 
  • Problem in blood coagulation or patient having anti-coagulants in past medical history are advised to not have Thoracentesis. 
  • Loculated effusion (when excessive pleural fluid is present in localized area of pleural space). So it is a complication and mostly Thoracentesis is contraindicated in this condition. In loculated effusion, the primary step is to check out area of effusion. Fluoroscopy, ultrasound and computed tomography are the techniques which are used for this purpose. If empyema is also present then local area with effusion cannot be identified on the basis of physical examination. As a result excessive needle puncturing will cause pain and patient become uncomfortable. Ultrasound is considered a best technique for this purpose. It can also be performed when patient is lying on bed side. 
Thoracentesis is contraindicated in patients who are on ventilator because there are more risks as compare to benefits in such patients. Some risks are:
  • Lungs may get collapse during Thoracentesis. Needle during this process may accidently puncture lungs and as a result lung will collapse leading to heavy breathing and ultimately death. So physicians recommend not to take small effusions and postpone this procedure if it is not urgent. 
  • Another main risk associated with patients on ventilator is about seating and positioning of patient. Patient can be positioned in two ways i.e. lie on bed side or sit lying on side table. Sitting position is easier to work with. But patient may not sit during Thoracentesis because of hemodynamic status and mental status. Tubes and indwelling lines used during Thoracentesis also complicate the process. If patient lie on bed side, then try to lift dependent diaphragm up. 5th or 6th interspace is recommended for needle puncturing because there are less chances of diaphragmatic injury in this region. 
  • Patient having coagulation defect is strictly contraindicated to Thoracentesis. Physician have to cover coagulation defect with medications and then Thoracentesis can be performed otherwise it can be proved fatal for patient.  If patient is already on ani coagulative medications, then he have to quit them immediately.