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Thoracentesis is a common bedside procedure associated with iatrogenic complications including pneumothorax. Experienced clinicians using optimal procedural techniques within a supportive system can achieve improvements in safety. However, clinicians have been relatively slow to adopt these changes. This review examines the available literature regarding procedural safety of thoracentesis with emphasis on best practice models to reduce iatrogenic complications.Recent studies have identified procedure-specific variables that are independently associated with iatrogenic pneumothorax including inexperienced operators, lack of ultrasound imaging, and large-volume aspiration of fluid. Development of a best practice model including procedural training within a focused procedural group that utilizes ultrasound imaging further improves thoracentesis procedural safety.Several procedural modifications have led to improvements in thoracentesis procedural safety in reducing iatrogenic complications. Herein, we review the known risks associated with thoracentesis and identify the modifiable and nonmodifiable risk factors. On the basis of recent studies, we make recommendations and encourage incorporation of ‘best practice’ techniques for thoracentesis procedures.