What are the contraindications to diagnostic thoracentesis the workup for pleural effusion (fluid on the lungs)?

Updated: Dec 28, 2018
  • Author: Kamran Boka, MD, MS; Chief Editor: Guy W Soo Hoo, MD, MPH  more...
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Relative contraindications to diagnostic thoracentesis include a small volume of fluid (< 1 cm thickness on a lateral decubitus film), bleeding diathesis or systemic anticoagulation, mechanical ventilation, and cutaneous disease over the proposed puncture site. Reversal of coagulopathy or thrombocytopenia may not be necessary as long as the procedure is performed under ultrasound guidance by an experienced operator. [36] Mechanical ventilation with positive end-expiratory pressure does not increase the risk of pneumothorax after thoracentesis, but it increases the likelihood of severe complications (tension pneumothorax or persistent bronchopleural fistula) if the lung is punctured. An uncooperative patient is an absolute contraindication for this procedure.

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