Evaluation of the Risk of Intercostal Artery Laceration During Thoracentesis in Elderly Patients by Using 3D-CT Angiography

Yoneyama, Hiroshi; Arahata, Masahisa; Temaru, Rie; Ishizaka, Shigeaki; Minami, Shinji

doi:10.2169/internalmedicine.49.2618

Cited by 32 publications

(28 citation statements)

References 3 publications

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“…This tendency decreases with increasing distance from the spinal column, and the artery is usually protected, even in older individuals, at the point where the ribs angle forward. 11 Our practice is to perform all chest tube insertions (and thoracenteses) laterally at or anterior to the posterior axillary line, unless loculations necessitate a posterior approach. Ultrasound guidance is essential for this approach and is a second factor that we believe would decrease the incidence of complications due to chest tube insertion.…”

Section: Discussionmentioning

confidence: 99%

Is chest tube insertion with ultrasound guidance safe in patients using clopidogrel?

et al. 2012

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Section: Discussionmentioning

confidence: 99%

Is chest tube insertion with ultrasound guidance safe in patients using clopidogrel?

et al. 2012

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“…92 The ICA is more exposed in the intercostal space within the first 6 cm lateral to the spinous processes and can be seen as far lateral as the midaxillary line. [92][93][94][95] Thus, the ICA will most likely be avoided if a procedure site is selected >6 cm lateral to the spinous processes and the needle is inserted above the rib. Second, although all three studies conducted using real-time (dynamic) ultrasound guidance reported a pneumothorax rate of <1%, it is uncertain whether real-time ultrasound guidance confers any additional benefit compared to static guidance for site marking as direct comparisons were not made.…”

Section: Knowledge Gapsmentioning

confidence: 99%

Recommendations on the Use of Ultrasound Guidance for Adult Thoracentesis: A Position Statement of the Society of Hospital Medicine

Dancel

Schnobrich

Puri

et al. 2018

Journal of Hospital Medicine

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Executive Summary: 1) We recommend that ultrasound should be used to guide thoracentesis to reduce the risk of complications, the most common being pneumothorax. 2) We recommend that ultrasound guidance should be used to increase the success rate of thoracentesis. 3) We recommend that ultrasound-guided thoracentesis should be performed or closely supervised by experienced operators. 4) We suggest that ultrasound guidance be used to reduce the risk of complications from thoracentesis in mechanically ventilated patients. 5) We recommend that ultrasound should be used to identify the chest wall, pleura, diaphragm, lung, and subdiaphragmatic organs throughout the respiratory cycle before selecting a needle insertion site. 6) We recommend that ultrasound should be used to detect the presence or absence of an effusion and approximate the volume of pleural fluid to guide clinical decision-making. 7) We recommend that ultrasound should be used to detect complex sonographic features, such as septations, to guide clinical decision-making regarding the timing and method of pleural drainage. 8) We suggest that ultrasound be used to measure the depth from the skin surface to the parietal pleura to help select an appropriate length needle and determine the maximum needle insertion depth. 9) We suggest that ultrasound be used to evaluate normal lung sliding pre- and postprocedure to rule out pneumothorax. 10) We suggest avoiding delay or interval change in patient position from the time of marking the needle insertion site to performing the thoracentesis. 11) We recommend against performing routine postprocedure chest radiographs in patients who have undergone thoracentesis successfully with ultrasound guidance and are asymptomatic with normal lung sliding postprocedure. 12) We recommend that novices who use ultrasound guidance for thoracentesis should receive focused training in lung and pleural ultrasonography and hands-on practice in procedural technique. 13) We suggest that novices undergo simulation-based training prior to performing ultrasound-guided thoracentesis on patients. 14) Learning curves for novices to become competent in lung ultrasound and ultrasound-guided thoracentesis are not completely understood, and we recommend that training should be tailored to the skill acquisition of the learner and the resources of the institution.

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“…However, the ICA can have a tortuous and unpredictable course. [45][46][47][48][49] In a CT scan study of 81 patients, Choi et al demonstrated increased tortuosity in elderly patients which decreased the effective ''safe'' space for puncture. 47 Yoneyama and colleagues also performed a CT angiography study in elderly patients and found that the lateral side (9-10 cm from spine) had a larger percentage area of safety than the medial side (5-6 cm from spine; 79.8% vs 61.2%; P < .0001).…”

Section: Anatomy Of Thoracentesis: Aiming For the ''Triangle Of Safety''mentioning

confidence: 99%

Thoracentesis

DeBiasi

Puchalski

2016

PLEURA

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Pleural effusions are common and account for high morbidity and mortality in a range of patients. Thoracentesis can provide significant symptom relief and improvement in physiologic parameters including dyspnea, exercise, and sleep. Recent advances, including the use of ultrasound and dedicated procedural teams, have improved the safety of thoracentesis. This has allowed thoracentesis to be performed on higher-risk individuals including those with elevated bleeding risk and bilateral pleural effusions. This review will summarize recent advances in thoracentesis procedural safety, symptom relief following thoracentesis, and understanding of the physiologic basis for such improvements.

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Evaluation of the Risk of Intercostal Artery Laceration During Thoracentesis in Elderly Patients by Using 3D-CT Angiography

Abstract: Objective Our study was undertaken to determine the location of the tortuous intercostal artery in elderly patients by using

Cited by 32 publications

References 3 publications

Is chest tube insertion with ultrasound guidance safe in patients using clopidogrel?

Is chest tube insertion with ultrasound guidance safe in patients using clopidogrel?

Recommendations on the Use of Ultrasound Guidance for Adult Thoracentesis: A Position Statement of the Society of Hospital Medicine

Thoracentesis

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