Categories
Procedure

Pleural Tap / Thoracentesis

Last Updated on April 9, 2023

Introduction

  1. Therapeutic
  2. 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
Position of thoracocentesis

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

Related Posts

  1. Pleural effusion
  2. Chest tube

Reference

  1. Pleural tap, by LIFTL
  2. https://www.sciencedirect.com/topics/medicine-and-dentistry/thoracentesis

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