This blog will offer some expert recommendations to help guide the safety of hospital procedures at different platelet and coagulation profiles. Unfortunately, there are no strong evidence-based guidelines for hospital procedures dedicated to the study of patients with decompensated cirrhosis.…
Read MoreA historical myth in procedural medicine is the operator should limit removal of pleural fluid to 1.5 L during thoracentesis because of the risk of re-expansion pulmonary edema or pneumothorax. New evidence supports safety of large volume thoracentesis until no…
Read MoreHow to Differentiate Pleural Effusion Exudates from Transudates Historically, Light’s criteria have been used to classify pleural effusions into transudates or exudates. Light’s criteria were established by Dr. Richard Light in 1972.[1] These criteria maximize sensitivity but have a…
Read MoreMore Articles – ascites, Featured, hepatic hydrothorax, HPC Updates, pleural effusions, Thoracentesis
More Tags – ascites, cirrhosis, featured, hepatic hydrothorax, HPC updates, pleural effusion, thoracentesis
This blog summarizes a recent update reviewing current management recommendations for hepatic hydrothorax (HH). Hepatic hydrothorax is a complication of decompensated cirrhosis with portal hypertension. Sixty percent of patients accumulate both ascitic fluid and pleural fluid as a result of portal…
Read MoreMore Articles – Anticoagulation, antiplatelets, central lines, Chest tube, chest tubes, coagulopathy, Featured, HPC update, Lumbar Puncture, Paracentesis, procedures, Thoracentesis
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…
Read MoreHistorically, it was felt that a platelet count below 50,000 or an INR>1.5 was a contraindication to thoracentesis for an increased bleeding risk. These were arbitrary cut-offs that have since been challenged with newer kits and the use of ultrasound-guided…
Read MoreHow to Differentiate Pleural Effusion Exudates from Transudates Historically, Light’s criteria have been used to classify pleural effusions into transudates or exudates. Light’s criteria were established by Dr. Richard Light in 1972.[1] These criteria maximize sensitivity but have a lower…
Read MorePleural 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…
Read MoreMore Articles – Catheter, Guidelines, HPC Updates, Saftey techniques, Thoracentesis, Ultrasound-Guided Thoracentesis
Recent studies have determined the best technique for improving the safety of thoracentesis. The patient should be sitting as upright as possible. Then, ultrasound the posterior back and locate a catheter insertion point at least 6 cm lateral to the…
Read MoreOriginal studies of ultrasound-guided thoracentesis concluded a 2% risk of pneumothorax. A recent single center study of 9320 thoracenteses over 12 years all by procedural experts had pneumothorax rate of 0.6%. This same study also demonstrated a very low incidence…
Read MoreA prospective cohort single center study was conducted to analyze the risk associated with patients undergoing thoracentesis or small-bore chest tube placement while taking clopidogrel. Twenty-five patients taking clopidogrel gave consent to remain on the antiplatelet medication while undergoing thoracentesis…
Read MoreThoracentesis is one of the most common bedside procedures performed in U.S. hospitals. There are about 173,000 thoracenteses performed each year in the U.S. A systematic review and meta-analysis in 2010 concluded that thoracentesis-related pneumothorax occurs 6% of the time…
Read MoreNumerous studies have shown that ultrasound guidance lowers the rate of complications and increases the success rate for virtually every hospital procedure compared with traditional landmark-based techniques. This has proved to be the case for ultrasound-guided central lines, ultrasound-guided paracentesis,…
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