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97 Thoracentesis

783

 

 

Step 7: Send pleural fluid for the laboratory tests

Routine investigations

¥Biochemical analysisÑpH level (in heparinised syringe), glucose levels, protein levels, albumin, lactic acid dehydrogenase levels, and adenosine deaminase

¥Microbiology examinationÑGram stain, fungal stain, AFB stain and culture, and aerobic culture

¥Total cell count and differential cell count

¥Cytology

Special investigation

¥Creatinine levels and pH for urinothorax

¥Amylase levelsÑif there is a pretest suspicion of acute pancreatitis, chronic pancreatic disease, or esophageal rupture

¥Triglyceride levels for chylothorax

¥Rheumatoid factor for rheumatic lung disease

¥Pro-BNP levels for congestive heart failure

¥Hematocrit levels for hemothorax

Suggested Reading

1.Duncan DR, Morgenthaler TI, Ryu JH, Daniels CE. Reducing iatrogenic risk in thoracentesis: establishing best practice via experiential training in a zero-risk environment. Chest. 2009;135(5): 1315Ð20.

An improvement program that included simulation, ultrasound guidance, competency testing, and performance feedback reduced iatrogenic risk to patients.

2.Porcel JM. Tuberculous pleural effusion. Lung. 2009;187(5):263Ð70.

A review article on the management of tubercular pleural effusion.

3.Celik B, Sahin E, Nadir A, Kaptanoglu M. Iatrogenic pneumothorax: etiology, incidence and risk factors. Thorac Cardiovasc Surg. 2009;57(5):286Ð90.

At training hospitals the incidence of Iatrogenic pneumothorax (IPnx) will increase in parallel to the increase in invasive procedures. Invasive procedures should be performed by experienced personnel or under their supervision when risk factors are involved.

4.Conner BD, Lee YCG, Branca P, et al. Variations in pleural ßuid WBC count and differential counts with different sample containers and different methods. Chest. 2003;123:1181Ð87.

The WBC counts obtained manually and with the automated counter from pleural fluid samples in EDTA tubes correlated very closely. The pleural fluid WBC count was lower if the pleural fluids had been collected in tubes without an anticoagulant.

5.Branca P, Rodriguez RM, Rogers JT, et al. Routine measurement of pleural ßuid amylase is not indicated. Arch Intern Med. 2001;161:228Ð32.

Pleural fluid serum amylase levels can be measured only if there is a pretest suspicion of acute pancreatitis, chronic pancreatic disease, or esophageal rupture.

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