Contraindications

  • Local infection over proposed site of thoracentesis (e.g. cellulitis, herpes zoster). Select another entry site
  • Uncontrolled bleeding
  • Coagulopathy is a relative contraindication; some data suggest it is safe to perform thoracentesis in patients with mild PTT elevations (<1.5 times the upper limit of normal). The decision to use reversal agents in patients with severe coagulopathy or platelet transfusion in those with clinically significant thrombocytopenia must be made on an individual basis
  • Caution must be exerted when performing thoracentesis in mechanically ventilated patients. The positive pressure of the ventilator may expand the lung to greater than normal volumes, increasing the potential risk of pneumothorax. Ultrasound-guided thoracentesis is recommended in this situation
  • Defer thoracentesis in patients with severe hemodynamic or respiratory compromise until the underlying condition is stabilized
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