Pleural Tap


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


  • 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


  • 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 8th intercostal space).
  • Note: If the effusion is poorly defined clinically do not proceed; request USS to mark the effusion.

References and Links

CCC 700 6

Critical Care


BA MA (Oxon) MBChB (Edin) FACEM FFSEM. Emergency physician, Sir Charles Gairdner Hospital.  Passion for rugby; medical history; medical education; and asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | Twitter |

One comment

  1. Informative session ,Thank u v.much , Excuse me i ‘m wondering about something , I did thoracocentesis many times either therapeutic or diagnostic, but in one pt with ESRD+ suspected Pulmonary TB + TB effusion, I remembered that I did it well in the midscapular line just below the upper border of effusion,as described above it was on the rt side, I used 18 or 16 Fr cannula during that procedure, while I am introducing the needle and aspirating and no fluid is coming ,I felt that like I touched a tough surface ,so I retract the needle back and aspirate ,there was difficult aspirations , and small amounts of blood ( which slots in the tube)only aspirated , my question is what could be this organ I touched that gave the crash sound , normal Lung parenchyma ?or it is consolidated lung or is other organ??, and how to deal with like this case if I got blood that clots in needle or tube when aspirating??

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