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Unilateral Thoracentesis Via Manual Drainage Vs Vacuum Bottle Suction: A Randomized Trial
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A4207 - Unilateral Thoracentesis Via Manual Drainage Vs Vacuum Bottle Suction: A Randomized Trial
Author Block: A. S. Ray1, M. Senitko2, T. E. Murphy1, K. L. B. Araujo1, Z. Dabre1, M. A. Pisani1, E. M. DeBiasi1, K. T. Bramley1, J. T. Puchalski1; 1Yale University School of Medicine, New Haven, CT, United States, 2University of Mississippi School of Medicine, Jackson, MS, United States.
Introduction: Thoracentesis is commonly performed for the evaluation and management of pleural effusions. Fluid may be aspirated manually or via vacuum suction. We report the first study comparing safety and comfort of these two techniques during thoracentesis.
Method: We prospectively randomized 100 patients who underwent ultrasound-guided unilateral thoracentesis in an academic medical center from December 2016 through September 2017. A 6-Fr Safe-T-Centesis™ (Carefusion) catheter was used with both manual aspiration and with use of the evacuated containers (Baxter). Thoracentesis was performed by advanced practice providers, pulmonary fellows or interventional pulmonary attendings. The pleural effusion was drained completely or until limited by patient intolerance. Pleural manometry was not used. Post-procedure chest radiographs were obtained. Specimens were routinely sent for analysis to categorize transudates and exudates and to better define the suspected etiology. Data included volume removed, time required for completion of drainage, and self-reported pain before and during the procedure as measured on a NPRS scale from 0 - 10. The primary end point was rate of complications with secondary analyses of drainage time, pain and early termination of the procedure - before fluid was completely drained.
Results: Patient characteristics in the manual (n=49) and vacuum aspiration (n=51) groups were similar. There was no association between aspiration type and difference in volume of fluid removed (p-value 0.60). All-cause complications were higher in the vacuum group (5 vs 0, p-value 0.03), consisting of pneumothorax (n=3), surgically treated hemothorax resulting in death (n=1) and re-expansion of pulmonary edema causing respiratory failure (n=1). The vacuum aspiration group also exhibited greater pain during drainage (p-value 0.04) and more frequent early termination of the procedure (8 vs 1, p-value 0.018). Time required for drainage was less in the vacuum aspiration group (p-value 0.003).
Conclusion: Despite requiring less time, vacuum aspiration during thoracentesis is associated with more complications, greater pain, and more frequent early termination. While larger studies are needed, this pilot study suggests that manual aspiration provides greater safety and patient comfort.
Author Block: A. S. Ray1, M. Senitko2, T. E. Murphy1, K. L. B. Araujo1, Z. Dabre1, M. A. Pisani1, E. M. DeBiasi1, K. T. Bramley1, J. T. Puchalski1; 1Yale University School of Medicine, New Haven, CT, United States, 2University of Mississippi School of Medicine, Jackson, MS, United States.
Introduction: Thoracentesis is commonly performed for the evaluation and management of pleural effusions. Fluid may be aspirated manually or via vacuum suction. We report the first study comparing safety and comfort of these two techniques during thoracentesis.
Method: We prospectively randomized 100 patients who underwent ultrasound-guided unilateral thoracentesis in an academic medical center from December 2016 through September 2017. A 6-Fr Safe-T-Centesis™ (Carefusion) catheter was used with both manual aspiration and with use of the evacuated containers (Baxter). Thoracentesis was performed by advanced practice providers, pulmonary fellows or interventional pulmonary attendings. The pleural effusion was drained completely or until limited by patient intolerance. Pleural manometry was not used. Post-procedure chest radiographs were obtained. Specimens were routinely sent for analysis to categorize transudates and exudates and to better define the suspected etiology. Data included volume removed, time required for completion of drainage, and self-reported pain before and during the procedure as measured on a NPRS scale from 0 - 10. The primary end point was rate of complications with secondary analyses of drainage time, pain and early termination of the procedure - before fluid was completely drained.
Results: Patient characteristics in the manual (n=49) and vacuum aspiration (n=51) groups were similar. There was no association between aspiration type and difference in volume of fluid removed (p-value 0.60). All-cause complications were higher in the vacuum group (5 vs 0, p-value 0.03), consisting of pneumothorax (n=3), surgically treated hemothorax resulting in death (n=1) and re-expansion of pulmonary edema causing respiratory failure (n=1). The vacuum aspiration group also exhibited greater pain during drainage (p-value 0.04) and more frequent early termination of the procedure (8 vs 1, p-value 0.018). Time required for drainage was less in the vacuum aspiration group (p-value 0.003).
Conclusion: Despite requiring less time, vacuum aspiration during thoracentesis is associated with more complications, greater pain, and more frequent early termination. While larger studies are needed, this pilot study suggests that manual aspiration provides greater safety and patient comfort.
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