Immediately following a thoracentesis, which clinical manifestations indicate that a complication has occurred and the physician should be notified?
A. Serosanguineous drainage from the puncture site.
B. Increased temperature and blood pressure.
C. Increased pulse and pallor.
D. Hypotension and hypothermia.
Correct Answer: C. Increased pulse and pallor
Increased pulse and pallor are symptoms associated with shock. A compromised venous return may occur if there is a mediastinal shift as a result of excessive fluid removal. Usually, no more than 1 L of fluid is removed at one time to prevent this from occurring.
Option A: Complications include bleeding, pain, and infection at the point of needle entry. If the approach is made too high in the intercostal space damage to the coastal vasculature and nerve injury is possible.
Option B: If too much fluid is removed or if the fluid is removed too rapidly (eg using negative pressure chambers) re-expansion (aka post-expansion) pulmonary edema may occur. Removal of significant fluid volumes may also induce vasovagal physiology.
Option D: If the procedural needle/catheter is passed through diseased tissue prior to entering the chest cavity, that process can be extended into the chest space. For example, passing the needle through thoracic or pleural tumor can seed the thoracic cavity or passing the needle through a chest wall abscess or otherwise infected tissue can result in empyema.
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