Pleural Aspiration
Not yet clinically reviewed
This protocol was migrated from the earlier Pharmapedia and Ward Guide apps for educational use. Follow your hospital's own policies and consult seniors when in doubt.
Indications
- Pleural effusion of uncertain cause
- Effusions causing distress
- Suspected empyema thoracis
Precaution
- Severe bleeding or clotting disorders, e.g. hemophilia
- Premedication is advisable and may reduce the likelihood of syncope
- Examine the chest X-ray and the patient to verify the site of effusion.
Technique
- Position the patient comfortably straddling a chair and slightly rotated to the opposite side to splay the ribs.
Site
- Choose the aspiration site at least one intercostal space below the upper limit of zone of dullness to percussion in the posterior axillary line or area of maximum dullness
- Under strict aseptic precaution, cleanse the skin with an antiseptic solution
- Infiltrate the skin and tissues with 1% lignocaine plain down to and including the pleura
- Penetrate the pleura with the needle (just above the lower rib of the site selected, to avoid injury to intercostals vessels and nerves), aspirate to confirm the presence of an effusion
- With a 50 ml syringe, three-way tap and 14G needle and cannula, aspirate the effusion to dryness or until coughing or subjective distress occurs
- Pleural fluid should be sent for cytology in a citrated container. Use a sterile container for microbiological examination when required.
Technique
- Entry into the pleural space may produce a vasovagal syncope requiring IV atropine
- Pneumothorax or hemopneumothorax may occur but spontaneous resolution usually follows
- Rarely unilateral pulmonary edema may complicate the rapid removal of fluid
- Examine the patient and a get a chest X-ray after the procedure and repeat the chest X-ray if the patient subsequently becomes distressed
- Start antibiotics to prevent infection, when needed.
