Pleural Tap

Indication:

• Diagnostic
  • Determine the cause of pleural effusion.
• Therapeutic
  • Remove excess pleural fluid to assist respiration and provide symptomatic relief.

Clinical

• History: SOB, cough and pain
• Examination:
  • Hypoxia
  • Reduced AE on affected sides
  • Reduced vocal fremitus and resonance
  • Stony dull to percussion
  • Pleural rub only present in small effusions
• Investigation
  • CXR: Not abnormal until >175ml fluid present, initially blunted CPA with fluid level meniscus
  • USS: Estimates size and useful in thoracocentesis direction
  • CT Chest: Estimate size, loculation and confirmation of additional pathology e.g. tumour or PTE

Contraindications:

• Local skin infection
• Uncooperative patient
• Uncorrected bleeding diathesis (in particular platelets <50 and INR>2)
• Relative contraindication with bullous lung disease and small effusions

Defining the correct site:

• Mark the optimal site for aspiration, on the posterolateral aspect of the chest wall (midscapular or posterior axillary line), 1–2 intercostal spaces below the percussed upper border of the effusion.
• Ensure the proposed site is directly over a palpable intercostal space and above the level of the diaphragm (no lower than the 8^th intercostal space).
• Note: If the effusion is poorly defined clinically do not proceed; request USS to mark the effusion.

References and Links

• CCC – Pleural effusion
• CCC – Pleural tap
• CCC – Pleural fluid analysis
• Video of Thoracocentesis [Loyola University]