Vacuum vs Manual Drainage During Unilateral Thoracentesis

NCT ID: NCT03496987

Last Updated: 2023-07-14

Study Results

Results available

Outcome measurements, participant flow, baseline characteristics, and adverse events have been published for this study.

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

100 participants

Study Classification

INTERVENTIONAL

Study Start Date

2015-12-01

Study Completion Date

2018-03-01

Brief Summary

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The purpose of this study is to determine if there are any differences in terms of safety, pain, or drainage speed between thoracenteses via manual drainage vs vacuum suction.

Detailed Description

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Patients with pleural effusions routinely undergo thoracentesis in which a catheter is placed into the pleural space to remove the fluid both for diagnostic and therapeutic reasons. In this setting, large amounts (often liters) of fluid are removed to palliate the patient's symptoms of breathlessness.

Thoracentesis is the most commonly performed and least invasive method to remove pleural fluid. These frequently performed using a catheter drainage system where a small, flexible temporary catheter is inserted over a needle into the pleural cavity. After insertion of catheter into the pleural space, the operator has two drainage system options: 1. Manual drainage via syringe-pump that connects to drainage bag or 2. Drainage into a vacuum bottle. Both are routinely performed in almost every hospital in the United States.

Pleural pressure (Ppl) is determined by the elastic recoil properties of the lung and chest wall. Normal pleural pressure is estimated to be -3 to -5 cm H20 at functional residual capacity. During drainage of pleural fluid, negative pressure is applied either via syringe during manual drainage or via vacuum using vacuum drainage bottle. Hypothetically more negative pressure can translate to increased perception of pain or visceral pleural injury.

Two techniques (manual vs vacuum drainage) are used based on the operator preference and both are standard of care. To our knowledge there is no head to head comparison of these two available systems of drainages during thoracentesis of pleural effusions. Knowing if one is superior to the other will aid future clinicians.

Conditions

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Pleural Effusion Pleural Diseases Thoracic Diseases

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Patients are randomly assigned immediately before performing the procedure to either of the two investigational arms: manual drainage or vacuum bottle drainage.
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Manual Drainage

Patients undergo drainage of pleural fluid via manual (syringe) system

Group Type NO_INTERVENTION

No interventions assigned to this group

Vacuum Bottle Drainage

Patients undergo drainage of pleural fluid via a vacuum bottle system (evacuated cylinder)

Group Type EXPERIMENTAL

Vacuum Bottle Drainage

Intervention Type DEVICE

Patients undergo drainage via vacuum bottles

Interventions

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Vacuum Bottle Drainage

Patients undergo drainage via vacuum bottles

Intervention Type DEVICE

Other Intervention Names

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Evacuated Cylinder

Eligibility Criteria

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Inclusion Criteria

* Patients undergoing unilateral therapeutic thoracentesis

Exclusion Criteria

* Patients with a history of prior significant pleural or lung based procedures/surgeries (not a simple thoracentesis)
* Prior enrollment in this study
* Patients ability to comprehend and consent to this procedure and clearly communicate any pain or other symptoms that arise from this procedure
Minimum Eligible Age

18 Years

Maximum Eligible Age

99 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Institute on Aging (NIA)

NIH

Sponsor Role collaborator

Yale University

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Jonathan T Puchalski, MD, MEd

Role: PRINCIPAL_INVESTIGATOR

Yale University

References

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Puchalski JT, Argento AC, Murphy TE, Araujo KL, Pisani MA. The safety of thoracentesis in patients with uncorrected bleeding risk. Ann Am Thorac Soc. 2013 Aug;10(4):336-41. doi: 10.1513/AnnalsATS.201210-088OC.

Reference Type BACKGROUND
PMID: 23952852 (View on PubMed)

Jones PW, Moyers JP, Rogers JT, Rodriguez RM, Lee YC, Light RW. Ultrasound-guided thoracentesis: is it a safer method? Chest. 2003 Feb;123(2):418-23. doi: 10.1378/chest.123.2.418.

Reference Type BACKGROUND
PMID: 12576360 (View on PubMed)

Havelock T, Teoh R, Laws D, Gleeson F; BTS Pleural Disease Guideline Group. Pleural procedures and thoracic ultrasound: British Thoracic Society Pleural Disease Guideline 2010. Thorax. 2010 Aug;65 Suppl 2:ii61-76. doi: 10.1136/thx.2010.137026. No abstract available.

Reference Type BACKGROUND
PMID: 20696688 (View on PubMed)

Seneff MG, Corwin RW, Gold LH, Irwin RS. Complications associated with thoracocentesis. Chest. 1986 Jul;90(1):97-100. doi: 10.1378/chest.90.1.97.

Reference Type BACKGROUND
PMID: 3522123 (View on PubMed)

Roth BJ, Cragun WH, Grathwohl KW. Complications associated with thoracentesis. Arch Intern Med. 1991 Oct;151(10):2095-6. doi: 10.1001/archinte.151.10.2095a. No abstract available.

Reference Type BACKGROUND
PMID: 1929699 (View on PubMed)

Raptopoulos V, Davis LM, Lee G, Umali C, Lew R, Irwin RS. Factors affecting the development of pneumothorax associated with thoracentesis. AJR Am J Roentgenol. 1991 May;156(5):917-20. doi: 10.2214/ajr.156.5.2017951.

Reference Type BACKGROUND
PMID: 2017951 (View on PubMed)

Heidecker J, Huggins JT, Sahn SA, Doelken P. Pathophysiology of pneumothorax following ultrasound-guided thoracentesis. Chest. 2006 Oct;130(4):1173-84. doi: 10.1378/chest.130.4.1173.

Reference Type BACKGROUND
PMID: 17035453 (View on PubMed)

Josephson T, Nordenskjold CA, Larsson J, Rosenberg LU, Kaijser M. Amount drained at ultrasound-guided thoracentesis and risk of pneumothorax. Acta Radiol. 2009 Jan;50(1):42-7. doi: 10.1080/02841850802590460.

Reference Type BACKGROUND
PMID: 19052935 (View on PubMed)

Feller-Kopman D, Walkey A, Berkowitz D, Ernst A. The relationship of pleural pressure to symptom development during therapeutic thoracentesis. Chest. 2006 Jun;129(6):1556-60. doi: 10.1378/chest.129.6.1556.

Reference Type BACKGROUND
PMID: 16778274 (View on PubMed)

BEECH RD. Practical system for thoracentesis using the blood donor set. J Am Med Assoc. 1951 Aug 25;146(17):1597. doi: 10.1001/jama.1951.63670170006011d. No abstract available.

Reference Type BACKGROUND
PMID: 14861005 (View on PubMed)

ALBERTSON HA, LEAVITT D, GAMBLE JR. A simple method for doing a thoracentesis using a plasma-collecting vacuum bottle. J Thorac Surg. 1954 Nov;28(5):544-5. No abstract available.

Reference Type BACKGROUND
PMID: 13212859 (View on PubMed)

Puchalski JT, Argento AC, Murphy TE, Araujo KL, Oliva IB, Rubinowitz AN, Pisani MA. Etiologies of bilateral pleural effusions. Respir Med. 2013 Feb;107(2):284-91. doi: 10.1016/j.rmed.2012.10.004. Epub 2012 Dec 7.

Reference Type BACKGROUND
PMID: 23219348 (View on PubMed)

Petersen WG, Zimmerman R. Limited utility of chest radiograph after thoracentesis. Chest. 2000 Apr;117(4):1038-42. doi: 10.1378/chest.117.4.1038.

Reference Type BACKGROUND
PMID: 10767236 (View on PubMed)

Kelil T, Shyn PB, Wu LE, Levesque VM, Kacher D, Khorasani R, Silverman SG. Wall suction-assisted image-guided therapeutic paracentesis: a safe and less expensive alternative to evacuated bottles. Abdom Radiol (NY). 2016 Jul;41(7):1333-7. doi: 10.1007/s00261-016-0634-x.

Reference Type BACKGROUND
PMID: 27315094 (View on PubMed)

Alraiyes AH, Kheir F, Harris K, Gildea TR. How Much Negative Pressure Are We Generating During Thoracentesis? Ochsner J. 2017 Summer;17(2):138-140. No abstract available.

Reference Type BACKGROUND
PMID: 28638284 (View on PubMed)

Provided Documents

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Document Type: Study Protocol

View Document

Document Type: Statistical Analysis Plan

View Document

Document Type: Informed Consent Form

View Document

Other Identifiers

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P30AG021342

Identifier Type: NIH

Identifier Source: secondary_id

View Link

1511016858

Identifier Type: -

Identifier Source: org_study_id

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