Comparison between direct puncture trocar and Seldinger technique in ultrasound-guided drainage of pleural fluid collections (DIESEL study): A prospective observational study

Background and Objective: There is a paucity of data comparing the direct puncture trocar technique and the Seldinger technique for the drainage of pleural fluid collections with respect to technical and clinical success rates and complication rates. Methods: The pleural fluid collections were drained using either the direct puncture trocar or the Seldinger technique by a single operator under ultrasound guidance. Technical success rates, clinical success rates, pain scores determined using a visual analog scale, complication rates, and mortality rates were compared between the two techniques. Results: A total of 94 patients were included in the analysis. Technical success was achieved in 97.87% of cases in the Seldinger group and 91.48% in the direct puncture trocar group ( P = 0.30). Clinical success was achieved in 90.09% of cases in the Seldinger group and 89.13% in the direct puncture trocar group ( P = 0.50). Patients experienced more pain with the Seldinger technique in the immediate periprocedural period (median visual analog scale [VAS] score of 6) as compared to the direct puncture trocar group (median VAS score of 5) [ P = 0.003]. Direct puncture trocar technique was significantly faster (mean procedure duration of 4.30 ± 2.41 min (direct puncture trocar group) vs 7.89 ± 2.12 min (Seldinger group) [ P = 0.00]). Conclusion: The direct puncture trocar technique appears to provide comparable technical and clinical success to the Seldinger technique for ultrasound-guided pleural drainage, with shorter procedural duration and lower immediate pain perception. Larger randomized studies are required to confirm these findings.