Varying Suction Techniques in Thoracentesis

Abstract

Introduction: Thoracentesis is a common pulmonary procedure; however, great variability still exists in provider practices. Standard of care methods ranges from vacuum assisted to manual aspiration to use of wall suctioning. Few studies have compared efficiency, safety or patient comfort between different methods of pleural fluid evacuation. We sought to investigate which of three standard of care methods implemented most frequently at our institution took the least amount of time to perform and caused the least symptoms and complications. Methods: We performed a single center, randomized controlled study to determine which method of thoracentesis (wall suctioning [N = 15], manual aspiration [N = 8], or vacuum drainage [N = 12]) was the most efficient in terms of procedural time and post-procedural symptoms. 35 patients undergoing therapeutic thoracentesis were randomized to the study. Procedural time was recorded from the onset of pleural fluid drainage and was measured at 500 mL, 750 mL, 1000 mL and at termination of drainage. Pain and dyspnea scores were assessed on a verbal numerical pain rating sale (NRS) and Modified Borg Dyspnea Scale (MBS). Scores were reported pre-procedure, after thoracentesis catheter placement before fluid removal, after termination of drainage prior to removal of catheter, immediately after catheter removal, 5 minutes post-procedure, and 24 hours post-procedure. Results: The differences in procedural time among groups were significant ( p < 0.0001). Specifically, the vacuum bottle group had the shortest average procedure time compared to the other two methods ( p < 0.0001). There were no significant differences in pain pre-fluid, post-fluid, post-catheter insertion and at 5-min and 24-hr post procedure. The adjusted dyspnea score model did show a significant difference on dyspnea score 24-hr post procedure; specifically, vacuum bottle had the lowest score compared to manual and bottle suction ( p = 0.006 and p = 0.004; respectively. Discussion : This study comparing various methods of pleural fluid drainage reveals reduced procedural time with vacuum bottle drainage and suggests that vacuum bottle drainage in our study population was more efficient with less associated symptoms compared to the other two standard of care methods. These findings would benefit from further analysis in a larger, randomized study to corroborate our findings.