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A Prospective, Randomized Study Comparing Three Different Methods

Donna R. Grogan, MD; Richard S. Irwin, MD; Richard Channick, MD; Vassilios Raptopoulos, MD; Frederick J. Curley, MD; Thaddeus Bartter, MD; R. William Corwin, MD

Arch Intern Med. 1990;150(4):873-877.

Abstract
• 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.

(Arch Intern Med. 1990;150:873-877)

Author Affiliations
From the Departments of Medicine (Drs Grogan, Irwin, Channick, Curley, Bartter, and Corwin) and Radiology (Dr Raptopoulos), University of Massachusetts Medical School, Worcester.

Footnotes
Accepted for publication December 7,1989.

Read in part before the annual meeting of the American Thoracic Society, Cincinnati, Ohio, May 17,1989.

Reprint requests to University of Massachusetts Medical Center, 55 Lake Ave N, Worcester, MA 01655 (Dr Irwin).

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