Pediatric Thoracentesis and Chest Tube Placement

First, we will perform and ultrasound or CT scan to evaluate the amount, characteristic and exact location of the fluid or air. Then, your child's doctor in the Children's National Hospital Interventional Radiology program will inject a local numbing medication at the site where the fluid will be drained. 

The doctor will guide a small needle through the skin and into the fluid, then the fluid will be sucked out (aspirated) with a syringe. If it is likely the fluid will continue to accumulate, the doctor will place a drainage catheter, using live X-ray (fluoroscopy) for guidance. Your child will be protected by an X-ray shield. 

A small amount of fluid will be sent to the laboratory to determine the cause of the accumulation. 

Younger patients are usually given general anesthesia so they aren’t awake during the procedure. If the child is older or has medical problems that prevent us from using general anesthesia, we will sedation or only local numbing medicine.

Approximately 30 to 60 minutes. If a chest tube is placed, this will stay in place for several days.

The procedure is considered low risk. However, potential complications include:

• Bleeding
• Infection
• Collapse of the lung (pneumothorax)
• Bleeding into the chest (hemothorax)
• Injury to surrounding structures such as veins or arteries

Some children feel pain or discomfort at the needle insertion site, usually in the first day or two after the procedure. Medication can be given to improve the pain. 

We will place a bandage over the site. If your child doesn’t have a drainage catheter, you must keep the bandage dry and in place for 48 hours. Then you may remove the bandage and your child can shower or take a bath as usual.

If a catheter was placed, the bandage must remain dry and in place until the catheter is removed. In addition, the catheter will be secured with a locking device (StatLock^®) which must not be removed. You may sponge-bathe your child, as long as you keep the site dry. 

If a drainage catheter was inserted, your child will need to avoid activities that may result in a pull to the catheter. Children who don’t have a drainage catheter may resume normal activity within two or three days.