Thoracentesis Complications

Thoracentesis is a procedure which is performed to eject excessive fluid from pleural space. Pleural space consists of double membranous structure in which fluid is present. Pleural fluid provides cushioning and does not let the membranes of pleura to collapse. Pleural fluid is present in low volume in pleural space, when the volume exceeds from normal value, this condition is termed as pleural effusion. In this procedure a needle or a plastic two way catheter is used to eject excess fluid from pleural space.

After applying local anesthesia to patient chest wall a needle is injected. Needle after crossing chest wall reaches to pleural space and start ejecting pleural fluid. After completion of process, needle or catheter is removed and a bandage is applied to cover the site. Then some tests are performed to check success of this procedure. It is a safe procedure with increased success rate but there may be some risks and complications which can make it unsuccessful. There are some complications which are on minor level and some are potential complications. Some common risks are as follows:

  • During procedure, when needle is injected through chest wall, physician may accidently pass through the other membrane of pleural space and lungs got puncture. Due to this, air may come out in pleural space which in turn leads to unbalancing of lung surface tension and as a result lung get collapse. This condition is known as pneumothorax. Chest tube drainage is necessary in this condition if it is symptomatic. Pneumothorax can also occur due to introduction of air bubble from outside.
  • Due to puncturing of chest wall with needle, bleeding may occur and cause further complications like patient may become faint. 
  • Any kind of infection can occur if needle is not properly sanitized. To avoid occurrence of infection, surgeon clean the chest wall surface with an antiseptic before starting procedure. 
  • Liver and spleen may get injured but it is very rare. 
  • Patient may experience chest pain during thoracentesis. Pain occurs due to poor technique or use of local anesthetic. So to avoid pain, pre-medications are preferred. In case of local anesthesia, pain may persist for about 24 hours after procedure. If patient suffers from shoulder pain after procedure, then it means diaphragmatic pleura got pierced with needle accidentally. 
  • Patient may suffer from shortness of breath known as dyspnea. 
  • Hypoxemia is another complication which can interact with thoracentesis. 
  • Coughing during thoracentesis also causes problem in ejecting fluid from pleural space. To avoid cough during procedure, patient is asked to lie down on a bed side table facing downward. 
  • Hemothorax is another main complication. In this condition, an artery near the site may get puncture and leads to excessive bleeding. 
  • Vaso vagal syncope.
  • Empyema is considered the most dreadful complication. 
  • If patient is suffering from mesothelioma, then there are high chances of occurrence of tumor cells due to needle insertion. 
  • Subcutaneous seroma is also reported. It occurs when needle passes to subcutaneous tissue and extravasation occurs as a result.
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