Healthcare and Medicine Reference
In-Depth Information
Needle into
pleural space
Tu b e
Figure 9.6 Therapeutic pleural aspiration.
Pleural fl uid analysis
Note the pleural fl uid appearance (e.g. serous, blood tinged,
frank blood or purulent). Send the pleural fl uid for the following
Approximately 15 mL of fl uid.
Send fl uid in a white top universal container for microscopy,
cultures and sensitivities (M, C & S), and for acid/alcohol-fast
bacilli (AAFB) and Mycobacterium tuberculosis (TB) culture.
Sending some additional fl uid in blood culture bottles increases
the yield, especially for anaerobic organisms.
Approximately 15 mL of fl uid.
Send fl uid in a white top universal container for protein and lac-
Figure 9.4 Step-by-step guide: pleural aspiration. (a) Sterilising the area
using 2% chlorhexidine in 70% isopropyl alcohol. (b) Using a blue needle to
infi ltrate local anaesthetic. (c) Performing a diagnostic pleural aspiration.
(d) Performing a therapeutic pleural aspiration.
tate dehydrogenase (LDH).
Send fl uid in a grey top (fl uoride oxalate) bottle for glucose (low
in infection and rheumatoid arthritis).
With an empyema the pleural fl uid may appear purulent - do not
put these samples into a blood gas analyser. Non-purulent fl uid
can be put into an ABG syringe and the pH checked. A pleural fl uid
pH of <7.2 suggests an empyema or parapneumonic effusion.
Send as much fl uid as possible; aim for at least 20 mL.
If a delay in getting the fl uid to the lab is anticipated then store
the sample in a fridge.
Check amylase if suspected pancreatitis.
Check cholesterol and triglyceride if suspected chylothorax
('milky' pleural fl uid).
Check haematocrit if suspected haemothorax (present if
the haematocrit of the pleural fl uid is more than half of the
peripheral blood haematocrit).
Figure 9.5 Equipment for performing therapeutic pleural aspiration.
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