Last Updated on April 9, 2023
Introduction
- Therapeutic
- Diagnostic
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– Can be done clinically or ultrasound guided
Contraindications
- Uncooperative patients
- Bleeding tendency (INR >2 or Platelet <50)
- Local skin infection
Equipment
- 3-way cock stopper
- IV drip set
- Branula (e.g. green)
- Sterile towel
- Disposable sterile set
- Chlorhexidine
- Lignocaine
- CBD bag
Landmarks
- Posterolateral aspect of the chest wall (midscapular or posterior axillary line), 1–2 intercostal spaces below the percussed upper border of the effusion OR 5 – 10 cm lateral to spine
- Above diaphragm
Notes
Drainage
- Maximum: 1 liter – 1.5 liters for immediate symptomatic relief
- Subsequently, patient can be referred to IR for pigtail insertion for further drainage of the pleural effusion.
- Target e.g. 500 mL per shift (≈1.5 liter per day)
Investigations
• The following investigations are sent in the same setting of pleural tapping
• Pleural fluid will be classified as exudative or transudative, following Light’s criteria
(i) Pleural fluid
Usually, these are the common investigations sent for pleural fluid:
- Cytology
- C&S
- FEME
- Biochemistry (pH, glucose, LDH, protein)
- AFB
- MTB C&S
(ii) Blood
- Liver function test
- Serum LDH
(iii) Imaging
- Chest X ray post thoracocentesis