If a pleural effusion develops, which of the following actions best describes how the fluid can be removed from the pleural space and proper lung status restored?
A. Inserting a chest tube.
B. Performing thoracentesis.
C. Performing paracentesis.
D. Allowing the pleural effusion to drain by itself.
Correct Answer: B. Performing thoracentesis.
Performing thoracentesis is used to remove excess pleural fluid. The fluid is then analyzed to determine if it’s transudative or exudative. Transudates are substances that have passed through a membrane and usually occur in low protein states. Exudates are substances that have escaped from blood vessels. They contain an accumulation of cells and have a high specific gravity and a high lactate dehydrogenase level. Exudates usually occur in response to a malignancy, infection, or inflammatory process.
Option A: A chest tube is rarely necessary because the amount of fluid typically isn’t large enough to warrant such a measure. Physicians use a chest tube to create negative pressure in the chest cavity and allow re-expansion of the lung. It helps remove air (pneumothorax), blood (hemothorax), fluid (pleural effusion or hydrothorax), chyle (chylothorax), or purulence (empyema) from the intrathoracic space.
Option C: Paracentesis rule out spontaneous bacterial peritonitis in patients with known ascites presenting with concerning symptoms such as abdominal pain, fever, gastrointestinal bleed, worsening encephalopathy, new or worsening renal or liver failure, hypotension, or other symptoms of infection or sepsis.
Option D: Pleural effusions can’t drain by themselves. In cases of complex parapneumonic effusions or empyema, (pleural fluid pH less than 7.2 or presence of organisms) chest tube drainage is usually indicated along with antibiotics. Small-bore drains (10 G to 14 G) are equally effective as large-bore drains for this purpose.
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