Risk factors of iatrogenic pneumothorax after thoracentesis in a clinical setting

ABSTRACT

Pleural effusion is a pathology that affects 1.5 million people in the United States every year. The treatment for pleural effusion is typically thoracentesis, which has several risks, such as pneumothorax, that can be life threatening and can pose a significant financial burden on patients and their families. Isolating and identifying the risk factors associated with pneumothorax after thoracentesis will help improve patient safety. The research for this literature review came from the referenced peer-reviewed scholarly articles that included other literature reviews, research papers, and research studies. Numerous articles were initially reviewed and several were excluded from this review due to their date of publication. Identifying risk factors had a positive impact on patient outcomes. Pneumothorax following thoracentesis was associated with increased morbidity, mortality, and the length of hospital stay. Patients with pneumothorax were also more likely to require additional procedures such as invasive mechanical ventilation, hemodialysis, tracheostomy, and chest tube placement. Pathologies such as cystic fibrosis (CF), chronic obstructive pulmonary disease (COPD), malignancies, and congestive heart failure (CHF) can contribute to in increased risk of iatrogenic pneumothorax following thoracentesis. Intra-procedural ultrasound use, clinician experience, patient positioning, and needle gauge also affect the rate of pneumothorax. Proper risk management includes education, better training, use of ultrasound intra-procedurally and proper patient workups help minimize these risks. Pneumothorax is a significant complication of thoracentesis that warrants careful consideration. There is not enough research to narrow down actual risk factors, and research in this area would benefit mid-level providers such as physician assistants and radiology assistants who are becoming the main performers of these services.

Keywords: Pleural effusion, thoracentesis, pneumothorax, iatrogenic