Outpatient thoracentesis

[NewYorkDoctors]

Is doing a thoracentesis is viable outpatient procedure?

I would imagine not because of the need for chest tube placement in the event of a PTX. Though if the outpatient center is nearby, or there is imminent IP support/CTSx support next door, and the prevalent use of U/S to rule PTX, maybe this may be of a lesser issue?

Further, if it is that bad the patient should probably be getting a pig tail.

Though I wonder if one gets an outpatient consult for pleural effusion and the desire is there to obtain a diagnostic thoracentesis in an office setting under U/S guidance, would that be a doable procedure? Or the liability and potential for complications is too great?

In those situations, does one refer to ED for a diagnostic thora? Or refer to CTSx or refer to IP or IR?

---

Members don't see this ad.

 

[Vigileo]

We do these as fellows in our VA clinic, and every so often in the university clinic. IP at at the university does them commonly in clinic. U/S is available and used pre and post procedure. CXR f/u if concerned. Also, IP isn't needed for a basic pigtail for a PTX. And I've worked at two different academic medical centers, and the ED never did thoracenteses and the residents really had no idea how to do them.

 

[NewYorkDoctors]

We do these as fellows in our VA clinic, and every so often in the university clinic. IP at at the university does them commonly in clinic. U/S is available and used pre and post procedure. CXR f/u if concerned. Also, IP isn't needed for a basic pigtail for a PTX. And I've worked at two different academic medical centers, and the ED never did thoracenteses and the residents really had no idea how to do them.

Is the context for diagnostic thora or therapeutic thora for relief of chronic pleural effusion?

 

[Vigileo]

The experience at my place is 90+% are for diagnosis. Most therapeutic thoras are done inpatient. If someone has recurrent effusions and meets other criteria (malignant, etc), then often we have them come in for PleurX drains. I can't comment on the private practice world and how often thoracenteses are done in clinic.

 

[jdh71]

Is doing a thoracentesis is viable outpatient procedure?

I would imagine not because of the need for chest tube placement in the event of a PTX. Though if the outpatient center is nearby, or there is imminent IP support/CTSx support next door, and the prevalent use of U/S to rule PTX, maybe this may be of a lesser issue?

Further, if it is that bad the patient should probably be getting a pig tail.

Though I wonder if one gets an outpatient consult for pleural effusion and the desire is there to obtain a diagnostic thoracentesis in an office setting under U/S guidance, would that be a doable procedure? Or the liability and potential for complications is too great?

In those situations, does one refer to ED for a diagnostic thora? Or refer to CTSx or refer to IP or IR?

You can do them in the clinic, but practically speaking they are too much of a time sink for the amount of rvu you get for them. Let IR drain stuff for you. See more patients.

 

[HuskyMD Emeritus]

Majority of thoracentesis are done outpatient, both diagnostic and therapeutic. PleurX catheters can also be placed as outpatient. Thoracentesis is very simple to perform with or without ultrasound guidance, though the community standard is with ultrasound. I often see patient with pleural effusion as outpatient consultation, perform thoracentesis at the same appointment. Patients are happy, leaving the office with relief of shortness of breath. The only pneumothoraces I have to deal with are patients with trapped lungs, and placing chest tube will not be of much benefit.