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Reaccumulation of fluid or air is a possible complications, as are hypovolemic shock (shock caused by a lack of circulating blood) and infection. Patients are at increased risk for poor outcomes if they have a recent history of anticoagulant use, have very small effusions, have significant amounts of fluid, have poor health leading into this condition, have positive airway pressure, and have adhesions in the pleural space. A pneumothorax can sometimes be caused by the thoracentesis procedure. The use of ultrasound to guide the procedure can reduce the risk of pneumothorax.
Thoracentesis can also result in hemothorax, or bleeding within the thorax. In addition, such internal structures, as the diaphragm, spleen, or liver, can be damaged by needle insertion. Repeat thoracenteses can increase the risk of developing hypoproteinemia (a decrease in the amount of protein in the blood).
— Mark A. Mitchell
