Healthcare and Medicine Reference
In-Depth Information
Sampling: Pleural Aspiration
Nicola Sinden
West Midlands Rotation, Birmingham, UK
By the end of this chapter you should be able to:
understand the indications and contraindications for pleural
identify and understand the relevant anatomy
describe the procedure of performing a pleural aspiration
clinically assess a pleural effusion
understand the difference between and the causes of
transudative and exudative pleural effusions.
Pleural aspiration may be:
diagnostic (to determine the cause of a pleural effusion)
therapeutic (to relieve symptoms of dyspnoea).
Contraindications (relative)
Small volumes of fl uid or fl uid diffi cult to detect by examina-
tion (an ultrasound scan of the thorax with marking of a site for
aspiration can be helpful in these situations).
Deranged INR (ideally INR should be less than 1.5).
Severe underlying lung disease (complications of the procedure
Figure 9.1 A large left-sided pleural effusion.
may be life-threatening).
layers with the muscle fi bres running in different directions.
Lying between the innermost and the inner intercostal muscles
is the neurovascular bundle. The neurovascular bundle contains
the vein, artery and nerve (Figure 9.2a). It is imperative to avoid
this bundle when performing a pleural aspiration. The chances
of penetrating this bundle can be minimised by always insert-
ing the needle over the upper border of a rib rather than under
(Figure 9.2b).
The pleurae
The pleurae are really one continuous membrane which lines the
inner surface of the thoracic cavity and diaphragm (parietal pleura)
and covers the lungs (visceral pleura). Between this double layer
lies the pleural cavity. In pathological states this potential space can
expand and fi ll with excess liquid (pleural effusion; Figure 9.1) or
air (pneumothorax).
Step-by-step guide: pleural aspiration
The intercostal muscles and the neurovascular
The intercostal space between adjacent ribs is fi lled by the inter-
costal muscles. The intercostal muscles are composed of several
Give a full explanation to the patient in simple terms and
ensure they consent to the procedure.
Set up your trolley (Box 9.1). Figure 9.3 shows the
equipment required for a diagnostic aspiration.
Prepare your trolley as a sterile fi eld. Wear a plastic
disposable apron and sterile gloves, and take alcohol hand
rub with you.
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