Healthcare and Medicine Reference
In-Depth Information
Local anaesthetic should be infi ltrated into the skin, intercostal
When performing pleural aspiration, the needle should be
muscle and parietal pleura. Use a blue or orange needle initially
followed by the green needle to infi ltrate deeper. The needle
should be inserted just above the upper border of the rib to
avoid the intercostal neurovascular bundle. Always aspirate
before injecting local anaesthetic to ensure that you are not in
a blood vessel.
Confi rm the presence of the pneumothorax by aspirating air
inserted just above the upper border of the rib to avoid the inter-
costal neurovascular bundle.
If fl uid is diffi cult to detect clinically or initial attempts at aspira-
tion with a green (21G) needle are unsuccessful, request an ultra-
sound scan of the thorax with marking of a site for aspiration.
Do not aspirate more than 1.5 L of pleural fl uid due to the risk of
re-expansion pulmonary oedema.
with the green needle.
Whilst the local anaesthetic is left to work, attach the three-way
Handy hints/troubleshooting
tap to the 50-mL syringe.
Insert the large-bore cannula over the upper border of the rib,
Always use local anaesthetic - don't be tempted to convince your
remove the needle and attach the three-way tap and 50-mL
Aspirate 50 mL of air at a time into the syringe and expel the
patients that one needle is better than two!
If you are suspecting that the pleural fl uid might be very viscous
(as with an empyema) use a large-bore needle or cannula.
Remember to prescribe some PRN post-procedure analgesia.
air into the atmosphere. The patient may begin to cough during
the procedure. Continue to aspirate until either resistance is felt,
the patient coughs excessively, the patient experiences pain or
2.5 L of air is aspirated.
At the end of the procedure, remove the cannula and apply a
Always monitor the patient throughout the procedure; the pulse
oximeter is particularly important.
Further reading
dressing to the site.
Request a CXR post procedure. For a primary pneumothorax,
Antunes G, Neville E, Duffy J, Ali N. (2003) BTS Guidelines for the
Management of Malignant Pleural Effusions. Thorax 58 (Suppl II):
Chapman S, Robinson G, Stradling J, West S. (2005) Oxford Handbook of
Respiratory Medicine . Oxford University Press, Oxford.
Davies CWH, Gleeson FV, Davies RJO. (2003) BTS Guidelines for the
Management of Pleural Infection. Thorax 58 (Suppl II): ii18-ii28.
Henry M, Arnold T, Harvey J. (2003) BTS Guidelines for the Management of
Spontaneous Pneumothorax. Thorax 58 (Suppl II): ii39-ii52.
Light RW. (2002) Pleural effusion. N Engl J Med 346 (25); 1971-7.
Maskell NA, Butland RJA. (2003) BTS Guidelines for the Investigation of a
Unilateral Pleural Effusion in Adults. Thorax 58 (suppl II); ii8-ii17.
consider a second aspiration if the fi rst aspiration was not
Learning points
Aim to establish the cause of a pleural effusion by history, exami-
nation and pleural fl uid analysis. With transudates, treatment is
directed at the underlying cause, whereas with exudates, removal
of the fl uid with aspiration or intercostal drain insertion may be
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