This blog summarizes the 2019 Society of Interventional Radiology (SIR) for Periprocedural Management of Image-guided Procedures with regards to thrombocytopenia, coagulopathies, antiplatelets and anticoagulation.  The SIR guidelines are summarized as follows: Anticoagulation with heparin, LMWH, fondaparinux, argatroban, warfarin, DOAC, clopidogrel, ticagrelor…
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Traditional teaching is that chest tubes placed to evacuate a pneumothorax should be directed anterior and superior and to evacuate fluid should be directed posterior and inferior. A recent study examined the effect of specific chest tube position on chest…
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The optimal insertion site for tube thoracostomy is at the mid-axillary line in the triangle of safety.  This avoids any major nerves or arteries aside from the intercostal vessels.  Ultrasound-guided localization of this site performed better than palpation. In semi-elective…
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Chest tube placement, or tube thoracostomy, can be an anxiety-provoking procedure for both the patient AND the operator.  It can also be a very gratifying procedure for the operator when performed successfully and without patient discomfort. Here are a few…
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Pleural fluid pH is an important measure for determining the clinical management of pleural diseases. For example, a pleural fluid pH <7.2 in patients with suspected pleural infection should mandate the placement of a chest tube. However, pleural fluid pH…
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A recent meta-analysis of 13 studies that were investigating needle decompression compared data of sample size, mean chest wall thickness, and decompression success rates. The meta-analysis concluded that the needle decompression catheter should be at least 6.5 cm in length…
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