ObjectiveTo retrospectively analyze the incidence of bleeding during transbronchial needle aspiration (TBNA) procedures, so as to provide evidence for prevention and treatment of the condition. MethodsTBNA procedures were performed in 178 patients with enlarged mediastinal and/or hilar lymph nodes, who were treated in the People’s Hospital of Linyi. A total of 248 lymph node sites were punctured, including 100 for the groups of pretracheal and post-superior vena cava lymph nodes (4R), 10 for the groups of left paratracheal (aorta-pulmonary artery windows) lymph nodes (4L), 13 for the groups of pre-carinal lymph nodes (7),90 for the groups of sub-carinal lymph nodes (7), 12 for the groups of sub-subcarinal lymph nodes (7), 12 for the groups of right lung hilar lymph nodes (11R), and 11 for the groups of left lung hilar lymph nodes (11L).TBNA procedures were performed according to WANG’s TBNA positioning and punctured method. The sites and incidence rates of bleeding sites during the procedures were analyzed. ResultsThe highest incidence rate of bleeding (20%) was found during TBNA procedures in the sub-carinal lymph node groups (7) , and the lowest incidence rate was found (2%) in the pretracheal and post-superior vena cava lymph node groups (4R) .The incidence rates of bleeding were significantly different between different puncture sites as demonstrated by chi-square test (χ²=17.035,P=0.009). ConclusionPretracheal and post-superior vena cava lymph nodes (4R) and sub-carinal lymph nodes (7) are the most common TBNA puncture position in the airway. TBNA procedure at sub-carinal lymph nodes (7) has the highest risk of bleeding. The massive bleeding during TBNA procedures can be avoided by prior enhanced CT and/or endobronchial ultrasound (EBUS)-TBNA of the lung.