Complications associated with thoracentesis. A prospective, randomized study comparing three different methods

Arch Intern Med. 1990 Apr;150(4):873-7. doi: 10.1001/archinte.150.4.873.


To determine what role the technique plays in complications associated with thoracentesis performed by physicians in training, we undertook a prospective study of thoracentesis in the medical service at our institution in which the sampling method was randomized among needle, needle with catheter, and needle with direct sonographic guidance. Fifty-two spontaneously breathing, cooperative patients with free-flowing effusions obliterating more than half of the hemidiaphragm on an upright, posteroanterior chest roentgenogram were randomized. When we analyzed those complications that were potentially life-threatening (eg, pneumothorax) and/or placed patients at increased risk for further morbidity (eg, pneumothorax, dry tap, inadequate tap), the sonography-guided method was associated with significantly fewer serious complications (0 of 19) than the needle-catheter (9 of 18) or needle-only methods (5 of 15). The sonography-guided method was associated with fewer pneumothoraces (0 of 19) than the needle-catheter (7 of 18) or needle-only methods (3 of 15). The difference between needle-catheter and needle-only methods was not significant. From our results, we conclude that the method by which thoracentesis was performed significantly influenced the spectrum and frequency of complications, and the sonography-guided method was the safest.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Catheterization / instrumentation
  • Hematoma / etiology
  • Humans
  • Needles
  • Pain / etiology
  • Pleural Effusion / diagnosis*
  • Pneumothorax / etiology*
  • Prospective Studies
  • Punctures / adverse effects*
  • Punctures / methods
  • Randomized Controlled Trials as Topic
  • Ultrasonography