ABSTRACT
Definition, indications, and contraindications 535
Positioning patient for thoracentesis 535 Selecting the area for thoracentesis536 Thoracentesis instrumentation 536 General techniques 537 Examples of specific techniques 538
Closed-needle pleural biopsy540 Definition, indications, and
contraindications 540 General techniques, patient positioning, and
selecting the right area 540 The cope needle 541 The Abram’s needle 541 Complications from closed-needle
pleural biopsy 542
Chest tubes 542 Definition, indications, and
contraindications 542 Insertion techniques 543 Suturing and dressing544 Complications from chest tube insertion 545 The Denver “pleurx” pleural catheter
and shunts 545 Chest drainage devices 546
Definitions, indications, and contraindications 546
The one-, two-, and three-bottle systems547 Commercially available drainage systems 547
The one-way Heimlich valve548 Troubleshooting chest tubes 549 Education and training 549 Future directions 549 References 550
Health care providers today must do their best to choose the most appropriate diagnostic or therapeutic drainage procedure among those available for a particular patient. is is not always a simple task, demanding thought, expertise, and experience. Indications should be individualized. Ideally, operators should be aware of or experienced in several methods of drainage so that choices are based upon what is best for the patient and not on what is simply available within a single physician’s personal procedural arsenal. In the next paragraphs a step-by-step approach to several drainage techniques used to diagnose and treat patients with pleural diseases is described.
