Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN 55905, USA.
Curr Opin Pulm Med. 2011 Jul;17(4):232-6. doi: 10.1097/MCP.0b013e328345160b.
Thoracentesis is a common bedside procedure associated with iatrogenic complications including pneumothorax. Experienced clinicians using optimal procedural techniques within a supportive system can achieve improvements in safety. However, clinicians have been relatively slow to adopt these changes. This review examines the available literature regarding procedural safety of thoracentesis with emphasis on best practice models to reduce iatrogenic complications.
Recent studies have identified procedure-specific variables that are independently associated with iatrogenic pneumothorax including inexperienced operators, lack of ultrasound imaging, and large-volume aspiration of fluid. Development of a best practice model including procedural training within a focused procedural group that utilizes ultrasound imaging further improves thoracentesis procedural safety.
Several procedural modifications have led to improvements in thoracentesis procedural safety in reducing iatrogenic complications. Herein, we review the known risks associated with thoracentesis and identify the modifiable and nonmodifiable risk factors. On the basis of recent studies, we make recommendations and encourage incorporation of 'best practice' techniques for thoracentesis procedures.
胸腔穿刺术是一种常见的床边操作，与医源性并发症有关，包括气胸。经验丰富的临床医生在支持系统中使用最佳操作技术，可以提高安全性。然而，临床医生相对较慢地采用这些变化。本综述检查了有关胸腔穿刺术程序安全性的现有文献，重点是减少医源性并发症的最佳实践模型。
最近的研究确定了与医源性气胸独立相关的特定于操作的变量，包括无经验的操作人员、缺乏超声成像以及大量抽取液体。在一个专注于程序的小组内进行包括程序培训的最佳实践模型的开发，并使用超声成像进一步提高了胸腔穿刺术的程序安全性。
胸腔穿刺术的一些程序修改可改善程序安全性，减少医源性并发症。在此，我们回顾与胸腔穿刺术相关的已知风险，并确定可修改和不可修改的风险因素。根据最近的研究，我们提出建议并鼓励将“最佳实践”技术纳入胸腔穿刺术程序。
