Ultrasound-guided thoracenthesis: the V-point as a site for optimal drainage positioning

A Zanforlin, G Gavelli, D Oboldi, S Galletti
European Review for Medical and Pharmacological Sciences 2013, 17 (1): 25-8

INTRODUCTION: In the latest years the use of lung ultrasound is increasing in the evaluation of pleural effusions, because it makes follow-up easier and drainage more efficient by providing guidance on the most appropriate sampling site. However, no standardized approach for ultrasound-guided thoracenthesis is actually available.

AIM: To evaluate our usual ultrasonographic landmark as a possible standard site to perform thoracenthesis by assessing its value in terms of safety and efficiency (success at first attempt, drainage as complete as possible).

MATERIALS AND METHODS: Hospitalized patients with non organized pleural effusion underwent thoracenthesis after ultrasound evaluation. The point showing on ultrasound the maximum thickness of the effusion ("V-point") was chosen for drainage.

RESULTS: 45 ultrasound guided thoracenthesis were performed in 12 months. In 22 cases there were no complications; 16 cases of cough, 2 cases of mild dyspnea without desaturation, 4 cases of mild pain; 2 cases of complications requiring medical intervention occurred. No case of pneumothorax related to the procedure was detected. In all cases drainage was successful on the first attempt. The collected values of maximum thickness at V-point (min 3.4 cm - max 15.3 cm) and drained fluid volume (min 70 ml - max 2000 ml) showed a significative correlation (p < 0.0001). When the thickness was greater or equal to 9.9 cm, drained volume was always more than 1000 ml.

CONCLUSIONS: The measure of the maximum thickness at V-point provides high efficiency to ultrasound guided thoracentesis and allows to estimate the amount of fluid in the pleural cavity. It is also an easy parameter that makes the proposed method quick to learn and apply.  

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