Guidelines for Thoracentesis and Needle Biopsy of the Pleura

Sokolowski, Joseph W.; Burgher, Louis W.; Jones, Frederick L.; Patterson, James R.; Selecky, Paul A.

doi:10.1164/ajrccm/140.1.257

Cited by 52 publications

(18 citation statements)

References 2 publications

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“…PS assessed correct performance of thoracentesis according to a 21-item checklist (Table 1), which was developed for the thoracentesis procedure using relevant sources [13,14]. Each skill or action was scored as either 1 (i.e., performed correctly without any error) or 0 (i.e., performed incorrectly).…”

Section: Methodsmentioning

confidence: 99%

Learning curves and long-term outcome of simulation-based thoracentesis training for medical students

et al. 2011

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BackgroundSimulation-based medical education has been widely used in medical skills training; however, the effectiveness and long-term outcome of simulation-based training in thoracentesis requires further investigation. The purpose of this study was to assess the learning curve of simulation-based thoracentesis training, study skills retention and transfer of knowledge to a clinical setting following simulation-based education intervention in thoracentesis procedures.MethodsFifty-two medical students were enrolled in this study. Each participant performed five supervised trials on the simulator. Participant's performance was assessed by performance score (PS), procedure time (PT), and participant's confidence (PC). Learning curves for each variable were generated. Long-term outcome of the training was measured by the retesting and clinical performance evaluation 6 months and 1 year, respectively, after initial training on the simulator.ResultsSignificant improvements in PS, PT, and PC were noted among the first 3 to 4 test trials (p < 0.05). A plateau for PS, PT, and PC in the learning curves occurred in trial 4. Retesting 6 months after training yielded similar scores to trial 5 (p > 0.05). Clinical competency in thoracentesis was improved in participants who received simulation training relative to that of first year medical residents without such experience (p < 0.05).ConclusionsThis study demonstrates that simulation-based thoracentesis training can significantly improve an individual's performance. The saturation of learning from the simulator can be achieved after four practice sessions. Simulation-based training can assist in long-term retention of skills and can be partially transferred to clinical practice.

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Section: Methodsmentioning

confidence: 99%

Learning curves and long-term outcome of simulation-based thoracentesis training for medical students

et al. 2011

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“…Although several biochemical markers such as pleural fluid protein, LDH, and pH have proven to be invaluable in making an accurate distinction between exudative and transudative effusion [15], a considerable overlap has been found in the levels of these markers in malignant vs. non-malignant effusion. Our data, however, revealed that a high pleural fluid to serum LDH level correlated with malignant pleural involvement as well as increased mortality in patients with lymphoid malignancy.…”

Section: Discussionmentioning

confidence: 99%

Malignant pleural effusions in lymphoproliferative disorders

Ahmed

Shahid

Rimawi

et al. 2005

Leukemia & Lymphoma

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In order to determine variables that correlate with malignant pleural effusion and mortality in patients with lymphoproliferative disorders and pleural effusion, a retrospective study was performed. Clinical data of hospitalized patients with a lymphoid malignancy and pleural effusion who underwent thoracentesis from January 1993 to December 2002 were collected. A logistic regression analysis was carried out to determine prognostic variables that predict malignant pleural effusion and hospital mortality. There were 86 patients who were admitted on 91 occasions. The median age was 70 years (range 4 - 92) and the male:female ratio was 44:42. Sixty-four patients (74%) had advanced disease, 43 (50%) had received prior chemotherapy and 9 (10%) were in remission. Of 91 cases of pleural effusions, 44 (48%) were bilateral, 80 (88%) were exudates and 48 (53%) were due to malignant involvement of pleura. In multivariate analysis, symptomatic pleural effusion (odds ratio 10.3, 95% confidence interval 1.7 - 98.3), pleural fluid mesothelial cell count < 5% (odds ratio 8.0, 95% confidence interval 1.4 - 58.2), pleural fluid:serum lactate dehydrogenase (LDH) > or =1 (odds ratio 6.4, 95% confidence interval 1.2 - 45.6) and pleural fluid lymphocyte percentage > or =50 (odds ratio 6.4, 95% confidence interval 1.2 - 50) were significantly correlated with malignant effusion. A secondary cancer (odds ratio 11.9, 95% confidence interval 2.3 - 88.8), pleural fluid:serum LDH > or =1 (odds ratio 10.9, 95% confidence interval 2.6 - 64.9), and pneumonia (odds ratio 6.4, 95% confidence interval 1.7 - 28.6) were significantly correlated with hospital mortality. In conclusion, malignant pleural effusion is the common etiology of pleural effusion in patients with lymphoid malignancy. Many clinical and cytochemical markers have discriminatory values in identifying malignant effusion. A high pleural fluid to serum LDH level correlates with malignant pleural involvement and hospital mortality.

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“…Routine blood picture, chest X-ray, sputum for AFB microscopy, Mantoux test was done. A pleural fluid aspiration was done and pleural biopsy was performed on all patients using Abram's needle maintaining proper asepsis (according to American Thoracic Society Guideline) 11 . Collected specimens were subjected to histopathological examination.…”

Section: Methodsmentioning

confidence: 99%